Spain rolls out national pilot screening programme for early detection of lung cancer

In the coming days, Spain will begin a health project that could save the lives of thousands of people. Hospitals and health centres in all regions will launch a screening programme for the early detection of lung cancer. The initiative, which for now is only a pilot test, would significantly increase the survival rates of the tumour that causes the most deaths each year in the country, some 23,000, one death every twenty minutes.

The project has been launched thanks to the efforts of the Spanish Society of Pneumology and Thoracic Surgery (Separ) which, after years of preparation, has forged an alliance with the Spanish Association Against Cancer, patient organisations and the rest of the main scientific societies involved in the fight against this tumour (oncologists, radiologists, pathologists and family doctors). Their efforts and those of the management of the almost one hundred hospitals and health centres that will deploy the screening will provide the funding to launch the project, which urgently needs the financial support of the national and regional health ministries if it is to be completed successfully.

The aim of the project, known by the acronym Cassandra, is to screen and follow up over the next five years some 50,000 Spanish smokers or ex-smokers who are at risk of developing a lung tumour. The aim is to improve the chances of defeating the disease and to demonstrate to the authorities the feasibility and cost-effectiveness of implementing this kind of screening.

An effective system for the early detection of lung tumours would turn the fight against this pathology, which currently has a survival rate five years after diagnosis of no more than 20% because, in the vast majority of cases (eight out of ten), the diagnosis comes at a very advanced stage of the disease, where surgery, the most effective technique for achieving a cure, is no longer advisable or possible, due to the excessive development of the cancer or because metastasis has already begun. Tests in other European countries indicate that lung screening can increase patient survival and quality of life by 26%.

The project, moreover, will use the chest screening tests to detect other smoking-related diseases such as pneumonia, COPD, emphysema, coronary artery obstruction or asthma at an early stage.

The first Spanish hospital to implement the project will be the Ramón y Cajal hospital in Madrid, followed by its neighbour La Paz. Also, before 15 December, the first candidates will be treated in three hospitals in Barcelona, another in Salamanca and three more in Aragon. Health facilities in all regions will be incorporated week by week, with some 42 hospitals and one health centre per hospital before the end of the first quarter of 2024, which is when the Cassandra project is intended to be fully deployed.

Given the limited scope of the pilot, the first selection criteria for candidates will be smoking and age. Applicants for the programme will be citizens between 50 and 75 years of age, who smoke or have smoked in the last 15 years and who have consumed on average no less than 15 packs of cigarettes per year. They will be able to reach the screening through health centres or hospital specialists.

Cassandra's main tool is a low-dose radiation scan of the chest to try to detect malignant lung nodules. Participants will also undergo spirometry, to determine their lung capacity and bellows, and some centres will complete this with a blood test to look for tumour biomarkers that predict the problem before the nodules even appear. The programme is completed by a smoking cessation plan.