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Ricardo Santos
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ES05 - Value in Lung Cancer, from Screening to Treatment (ID 203)
- Event: WCLC 2020
- Type: Educational Session
- Track: Health Services Research/Health Economics
- Presentations: 1
- Moderators:
- Coordinates: 1/29/2021, 14:15 - 15:15, Scientific Program Auditorium
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ES05.04 - Lung Cancer Screening in Lower Resource Settings (ID 4040)
14:15 - 15:15 | Presenting Author(s): Ricardo Santos
- Abstract
- Presentation
Abstract not provided
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P41 - Screening and Early Detection - Lung Cancer Screening Programmes (ID 176)
- Event: WCLC 2020
- Type: Posters
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P41.05 - Challenges of Implementing Lung Cancer Screening in Brazil: Preliminary Results of a Multicenter Group (ID 2324)
00:00 - 00:00 | Presenting Author(s): Ricardo Santos
- Abstract
Introduction
The reality of lung cancer in Brazil is similar to that found around the world. High prevalence and lethality of the disease are related to cigarette use and late diagnosis, with more than 90% of cases in advanced stage. There is sufficient evidence in the literature to indicate indicate low dose computed tomoghraph (LDCT) screening for lung cancer; however, there are countless challenges to its implementation. In Brazil, after the results of International Early Lung Cancer Action Program (I-ELCAP), National Lung Screening Trial (NLST) and the First Brazilian Lung Screening Trial (BRELT1), efforts have been made to implement screening in different regions, most of them still endemic for granulomatous diseases. The National health system provides universal health coverage and it is consisted of public and private systems. We report here the initial results of the prevalence of lung cancer in a multi-institutional series, with independent experiences in both health systems, highlighting the challenges encountered in the process.
Methods
From march 2013 to june 2020, 3819 individuals were screened in five institutions located in different regions of the country. For homogeneous analysis of the data, we excluded all individuals submitted to tomography but who did not meet National Comprehensive Cancer Network (NCCN) and US Preventive Services Task Force (USPSTF) criteria. The LDCT exams were categorized according to the Lung-RADSTM classification (Lung-RADSTM 4A, B or X). Local multidisciplinary evaluation committees determined the biopsy method and therapeutic approach.
Results
A total of 3277 selected individuals (61% male), the mean age of 59.5 (SD 8.8), were screened with serial tomography based on the initial result (Baseline). Lung-RADSTM 4 were seen in 201 (6.1%) patients. A biopsy was indicated by minimally invasive methods in 99 (3%) patients. Lung cancer was diagnosed in 66 patients (prevalence rate of 2%). Stage I or II was observed in 43 of 54 patients (79.8%). In 13 cases, staging was not completed on the patient records. Granulomatous disease was confirmed in 20 patients (1%). Treatment was carried out according to the current international guidelines. The surgical teams have utilized minimally invasive techniques in all five institutions.
Conclusion
Lung cancer screening is been considered standard of care worldwide. In Brazil, difficulties in its implementation, related to the organization of the health system, access to CT scans and treatment methods, as well as cultural acceptance of the method, slow down the process. In a multi-institutional series, carried out independently in different regions of Brazil, it was possible to achieve similar results to the main international studies. Granulomatous diseases did not increase the number of lung biopsies. There are challenges and obstacles in carrying out the screening according to the local organization; however, in all scenarios it was possible to obtain satisfactory results.
