On March 28th I attended an excellent congress of the European Alliance of Personalized Medicine (EAPM) about lung cancer screening. Lectures and discussions had a very high level. But something was missing. For the man with the hammer the whole world looks like a CT-scanner. Screening is done with a CT-scanner. We have done it like that for 40 years and why change? Screening has become big business and that is why it is irreversible. In the seventies breast cancer screening was implemented and since then we have done it in the same way. A little adapted and modernized, but the fact remains that there has not really appeared a different view on screening. And the consequence is a lot of negative and a few positive effects. These negative effects can mainly be found in the field of ‘false positives’ (suspicion of cancer during the screening, but on second thoughts this is not the case) and overtreatment (during the operation for example it appears not to be a tumor). For information about screening of prostate and breast cancer see Harding Center for Risk Literacy: https://www.harding-center.mpg.de/en. In the seventies we were not wiser, but now we are. Politically it is not done to bring screening up for discussion and that is why we are continuing in an inevitable process.
Lung cancer is the biggest killer when we talk about cancer and we do too little about it. In Brussels I had people convince me of the necessity of screening. Screening can see to it that we discover lung cancer in stages 1 and 2. This is of great advantage in the chances to survive compared to stage 4. Consequently, I began to change of being an opponent of screening (because of the consequences mentioned) to a cautious and critical advocate. But for the lung cancer patients we will have to do better than we have done so far for breast cancer and prostate cancer patients. Then it is important not only to continue on our way of scanning, but also to add screening with genetics and liquid biopsy (and a combination of these) among other things. Defining who is in the risk group and experimenting with the new techniques now already. As long as the CT scan is common, we can already start adding the genetics and liquid biopsy mentioned. These techniques are already good, but can be made better, especially by experimenting. We can use them as extra information immediately and will benefit from them. CT scanning too can still be improved by using nano-ferro particles, as professor Jelle Barentsz has tried to introduce for years against the current of the Medical Industrial Complex. It was also informative to hear from professor Aad van der Lugt of the ErasmusMC that we are able to reduce false positives by using algorithms. Let mathematics help us.
Costs will be subject of discussion. Well, Mary Baker, a patient advocate from London, was clear about this. “How can we talk about the costs of screening and not look at the enormous societal costs of tobacco? At the personal suffering caused by the tobacco industry. We all know that investing in health leads to a better society. Health is wealth and costs in health care are an investment in society”. And finally, let one thing be clear: lung cancer patients are not to blame for their illness and death themselves. We blame them, but we have to put the blame on industry. Worldwide the industry, together with politicians and governments that refuse to act, has the responsibility for millions of deaths. That message has also been brought forward to the Members of the European Parliament. It does not make you popular, but it has to be done. Mary: “Let’s sit in the back, Peter, because I think they are going to throw rocks at us”.
Bonnie Addario · 27 april 2017 op 17:26
I LOVE this post. Please keep up the good work.
Louis Kyriakoudes · 27 april 2017 op 18:56
Yes, Peter. The tobacco problem must be solved. But putting patients at the center of diagnosis and care (and not doctors, big pharma, medical equipment makers and the like), as you say is central, too. Great work. I look forward to reading your future posts.