HomeKnowledge and experience exchange with Sweden: Early detection of lung cancer in never-smokers

Knowledge and experience exchange with Sweden: Early detection of lung cancer in never-smokers

Lung cancer accounts for one in five deaths worldwide. The past few years have seen considerable advances in treatment for lung cancer, yet the prognosis remains low. Lung cancer causes symptoms that come up late in the course of the disease and assessments are complicated. This means that half of the patients have a spread disease at diagnosis.

Early detection and prevention are the best strategies to improve the treatment outcome or eliminate the disease. People who smoke or have smoked have the greatest risk of lung cancer, though lung cancer also increasingly occurs in people who have never smoked. Lung cancer in never-smokers is a global rising concern and there is a fast growing need to understand how never-smokers’ disease differs from that of smokers, and how to effectively prevent and diagnose it early.

Vision Zero Cancer therefore invited participants ranging from current leading researchers in the field and clinicians to patient representatives and the medical industry to share experience and discoveries on how to develop an effective preventive strategy and opportunities for screening.

The meeting held around 30 participants and keynote speaker was Dr. Pan-Chyr Yang (MD, PhD, Chair Professor at the National Taiwan University Hospital and Academician of Academia Sinica, Taiwan). Dr. Yang shared the findings of the Taiwan Lung Cancer Screening for Never-Smoker Trial (TALENT), a nationwide lung cancer low-dose CT screening study focused on never-smokers which also aims to develop an effective strategy for screening of lung cancer in never-smokers and establish a risk prediction model to identify high-risk population that may benefit from low-dose CT screening. In Taiwan, lung cancer is the leading cause of cancer mortality, and 53% of those who have died of lung cancer were never-smokers. The US National Lung Cancer Screening Trial (NLCST) and the Dutch NELSON trials demonstrated that the use of low-dose CT is effective for lung cancer screening; however, most of the lung cancer screenings focused on heavy smokers.

Of the 12,011 individuals included in the trial, the prevalence of lung cancer was 3.2% and 2.0% in participants with and without lung cancer family history, respectively. As explained during the meeting by Dr. Yang, 96.5% of the detected patients were stage 0 or 1 and potentially curable by surgery. The study also demonstrated the high risk of family history, especially among participants with a first-degree family history of lung cancer.The meeting further contained a panel discussion where Andrew Kaufman (MD, Associate Professor, thoracic surgeon at Mount Sinai Hospital in New York City) Kersti Oselin (MD, PhD, Medical Oncologist, North-Estonian Regional Hospital Cancer Center) Marcela Ewing (MD, PhD, Specialist Oncology and General Medicine, Sahlgrenska Academy, Regional Lead Early Detection of Cancer, Confederation of Regional Cancer Centres) Mattias Johansson (PhD, Scientist, Genetic Epidemiology Group, International Agency for Research on Cancer (IARC), World Health Organization) and Mikael Johansson (MD, Associate Professor, Senior Consultant Oncology, Umeå University Hospital and Senior lecturer at Umeå University, Chair of the National Working Group for Lung Cancer Care) together with Dr. Pan-Chyr Yang elaborated their thoughts on the findings of the TALENT-study and how this relates to what they are facing in their current work.

Andrew Kaufman who is the leader of the never-smoking initiative at Mount Sinai Hospital, New York, reflected that caring for never-smoking lung cancer patients comes down to the intersection between epidemiology, biology, clinical capability, precision medicine, surgical care and all other clinical attributes available. He put emphasis on that it takes a multidisciplinary approach to look at the data and find out what is the substrate we are dealing with in terms of a clinical population, while also stating that for most cancers unfortunately the time for best intervention is at an asymptomatic time point. Dr. Kaufman continued by being hopeful that discussions like the one this meeting facilitated will shed light on and give direction to find the right thread to start pulling on to make a difference in the case of lung cancer. By learning from the important findings of Dr. Yangs work we will be able to provide ways to be smarter at identifying patients at risk yet also not increasing the costs of the inefficiency of care.

The various competent outlooks and insights presented by the panel gave a good transition to the last part of the meeting where Mattias Johansson from the Genetic Epidemiology Group at the WHO International Agency for Research on Cancer (IARC) presented a proof on concept study on the use of biomarkers to improve early detection and the possibilities this presents to detect more lung cancer patients in time. Medical oncologist Kersti Oselin from the North-Estonian Regional Hospital Cancer Center gave insights on AI for early detection and the prognostic significance of genomic markers in lung cancer recurrence. Rounding up the meeting from London Amied Shamaan, director within AI and clinical collaboration presented the work of a collaboration between Oxford University and GE Healthcare with other industry partners in a consortium that is formed around lung cancer screening and innovation and goes under the name of The Integration and Analysis of Data using Artificial Intelligence to Improve Patient Outcomes with Thoracic Diseases (DART). The consortium has come together to be agile around the lung cancer screening process in the UK to provide innovation in technology and to be able to involve and better affect the patient population.

During the autumn follow-up meetings will be held to dig deeper into the common areas and challenges facing early detection of never smokers. Leveraging clearly on the consensus of the meeting around the need to gather across professions and sectors to build momentum around who and how to find never-smoking lung cancer patients at the right time.

Watch the recording of the meeting.

Meeting agenda

The purpose of this meeting was to share discoveries and experience on how to develop an effective preventive strategy.

How do we detect cancer earlier?

The earlier cancer is detected, the greater are the chances of survival. With new systems and knowledge, we can pick up on symptoms earlier and more quickly come to treatment. And get more chances to reach the vision of zero people dying from cancer and more people living longer and better.

Early detection and diagnosis

HomePrecision medicine improves cancer care and makes it more equitable and efficient

Precision medicine improves cancer care and makes it more equitable and efficient

One size fits all is no longer applicable. Precision medicine has made several advancements in recent years. Rapid development in research and technology is creating conditions for a transformation of the system. With these developments come challenges and consequences – but which ones? And what exactly is accommodated within the concept of precision medicine? These questions where discussed among 60 participants at a digital round table recently hosted by Vision Zero Cancer and the Confederation of Regional Cancer Centers.

Many precision medicine initiatives are underway. In order to gather the scope of initiatives in Sweden, recapture the state of knowledge and sharpen collaboration, Vision Zero Cancer and the Confederation of Regional Cancer Centers extended invitations to a digital round table. Among the participants were representatives from healthcare, patient associations authorities, industry, academia and other experts.

So what is precision medicine? Precision medicine is about tailoring healthcare for a subgroup of patients. Based on genetics, environment and lifestyle factors, diagnostics, treatments, and decisions can be improved and become more precise. These include molecular biology, genetic sequencing, new imaging techniques, gene therapy, AI, machine learning and data management.

David Gisselsson Nord, MD, PhD, Professor and Specialist Physician, Senior Consultant in molecular pathology in the Southern Healthcare Region, gave examples from the reality of genetic sequencing in childhood cancer.
– Precision diagnostics will be of great benefit to many, says Dr. Gisselsson Nord, but he also points out that sometimes it only works for a certain period of time. We cannot have a static treatment when cancer is ever changing by nature.

Advancements in liquid biopsies, AI, blood tests and national collaborations

Richard Rosenquist Brandell, MD, PhD, Professor of clinical genetics at Karolinska Institutet and Senior Physician at Karolinska University Hospital, gave insights about the Swedish national collaboration Genomic Medicine Sweden (GMS), where he is chairman. GMS coordinates the introduction of precision medicine nationwide, with centers at the seven university hospitals and has launched a national genomics platform to share data across the country.
– We develop standards of how to analyze and interpret, how to work with precision diagnostics and build teams at each center that can use it in treatment. At the same time, it will be a good resource for research and innovation as we can collect the entire country’s data.

AI can improve the operational steps we already have today, rebuild workflows and, not least, do things that we couldn’t do before. Like predicting certain progress. But this also means that new competences in healthcare are needed, such as computer scientists.

Fredrik Enlund, Associate Professor of molecular pathology and head of the Centre for Diagnostics at Region Kalmar, talked about liquid biopsies, a special sampling that can capture the heterogeneity of tumors. That is, genetic clones and mutations within the same tumor.
– Heterogenous tumors are a challenge – which clone is to be primarily treated and what do we do when the patient has received targeted treatment but has developed a clone that can resist the primary treatment? This is where we benefit from liquid biopsies. They can capture that heterogeneity and reduce the risk of resistance if the disease develops. Liquid biopsies can also be used in hard-to-reach tumors to find the right treatment.

The possibilities that comes with AI are great for precision medicine, says Claes Lundström, Adjunct Professor at Linköping University and research director at Sectra. It can save a lot of time for those who work in healthcare and save lives.
– AI can improve the operational steps we already have today, rebuild workflows and, not least, do things that we couldn’t do before. Like predicting certain progress. But this also means that new competences in healthcare are needed, such as computer scientists.

Peter Nygren, MD, PhD, Senior Consultant and Professor of cancer pharmacology at Uppsala University and national coordinator of the MEGALiT project told us about the national cross-sectoral collaboration that under controllable conditions implement new ways of working within oncology.
– We will test tumor response, feasibility and safety of different drugs on different diagnoses, says Dr. Nygren. It paves the way for more advanced use of precision medicine in the next step.

There are certain crossroads in life where you meet healthcare providers. At the childcare center, at school related health services or in screening programs. While being in contact with healthcare, you could easily add taking a blood test to find biomarkers for cancer. Maybe the end goal could even be a simplified blood test to be taken home?

Precision medicine can also make it possible to earlier on detect diseases and find their predispositions. Beatrice Melin, MD, PhD, Senior Consultant and Professor at the Department of Radiation Sciences at Umeå University, pointed out that simple blood tests can provide many answers.
– There are certain crossroads in life where you meet healthcare providers. At the childcare center, at school related health services or in screening programs. While being in contact with healthcare, you could easily add taking a blood test to find biomarkers for cancer. Maybe the end goal could even be a simplified blood test to be taken home?

Authorities investigate the impact and benefits of precision medicine

The roundtable also offered an update from Swedish authorities on their ongoing investigations. Johan Strömblad, Project Manager at the Swedish Agency for Health and Care Services Analysis, talked about the impact of precision medicine on healthcare.
– Achieving the vision requires political priorities, resources to make necessary transitions, patient participation, integration of research and clinical practice, and health data amongst other things. We need to ask questions of how we further cross-sectoral development within knowledge management in the organization, what boundaries are applicable to national highly specialized care and which staff need what knowledge.

As treatments become more individualized for each patient, how do we evaluate the societal benefits of treatment?

Anna Alassaad, Pharmacist, and Project Manager at the Dental and Pharmaceutical Benefits Agency, reported on the health economic assessments for precision medicine – how payment models can be developed to address the high costs of treatment and uncertainties.
– As treatments become more individualized for each patient, how do we evaluate the societal benefits of treatment? This is one of the themes within the analysis. Another theme is value – precision medicine comes with new possibilities, such as earlier risk identification and possible cure. Are values such as these captured in traditional health economic analyses?

Several collaborative projects are developing precision medicine in cancer

Simon Ekman, MD, PhD, Senior Consultant and Associate Professor of oncology at Karolinska University, talked about the Partnership for Precision Medicine in Cancer (PPMC) – an initiative to strengthen Swedish translational research on precision medicine, with coordination of biobanking, clinical data and research data from patients. PPMC is a virtual organization with regional nodes in University hospitals and regional cancer centers.
– We want to achieve better precision in treatments, facilitate follow-ups and find new therapies, says Simon Ekman.

Work at the local level is essential for things to happen on the floor. It’s about building understanding among managers and employees about what precision medicine is. New ways of working are necessary and so is applying new ways of thinking about organization. Academia needs to become a clearer part of healthcare.

Anna Martling, MD, PhD, Professor of Surgery, Senior Consultant at Karolinska University Hospital and Dean of Campus North of Karolinska Institutet, leads the Taskforce for accelerated development of precision medicine. The goal is to accelerate development and coordinate activities within the Stockholm Region by working for implementation in healthcare in order for patients to reap the benefits.
– Work at the local level is essential for things to happen on the floor, Dr. Martling says. It’s about building understanding among managers and employees about what precision medicine is. New ways of working are necessary and so is applying new ways of thinking about organization. Academia needs to become a clearer part of healthcare.

We want to achieve better precision in treatments, facilitate follow-ups and find new therapies

The collaboration program of Health & Life Science is based on the Swedish Life Science strategy. Among other things, it states that Sweden should be a leader in the introduction of precision medicine. Frida Lundmark from The Research based Pharmaceutical Industry is coordinating the government’s liaison group around precision medicine.
– We’re going to act like the glue holding everything together. We won’t identify or initiate our own initiatives, but rather help and highlight the regional initiatives that are underway and further their conditions towards national dissemination and implementation, says Frida Lundmark. We will also structure proposals for the Government Offices of Sweden based on what is already initiated adding extra muscle and speed to enforcement.

Break-out groups provided input for further analysis

The 60 participants were towards the last hour divided into groups to discuss questions about what efforts will be required in the coming years for precision medicine to ensure good, equitable and effective cancer care, as well as which constellations of actors are needed to achieve this. Each group had been appointed a theme to give lead to the discussions, the themes ranged between technology, clinical trials and policy development.

Among the answers where proposals to standardize and coordinate payment models, data sharing and guidelines nationally. Many pointed to the importance of developing competence for existing staff within precision medicine, but also the need to introduce completely new competences and trainings. Several mentioned that the need, value and effects of different therapies, medicines and health economics must be evaluated. The proposals also touched upon increased understanding of the value of investing in research and placing Sweden on the international map. Further we need to get better at finding and involving patients in order for precision medicine to benefit those intended.

The result of the workshop will be part of the foundation for further work by Vision Zero Cancer and the Confederation of Regional Cancer Centers. It is hoped that these valuable insights can serve as starting points in further analyses and collaborations on various issues.

Thank you to all participants!

Better treatment, better lives

Chemotherapy also gives way to healthy cells. We want to find more precise treatment, focusing on the goal and on providing as little side effects as possible. Both during and after treatment. Because it is not just about survival, it is about continuing to live.

Treatment and Quality of Life

How do we detect cancer earlier?

The earlier cancer is detected, the greater are the chances of survival. With new systems and knowledge, we can pick up on symptoms earlier and more quickly come to treatment.

Early Detection and Diagnosis

HomeHow lung cancer can be detected and diagnosed earlier in Sweden

How lung cancer can be detected and diagnosed earlier in Sweden

Lung cancer is today the leading cause of death in Sweden. The earlier that lung cancer is detected, the greater are the chances of survival. A national screening programme has been brought to attention, but much needs to be resolved before we are there. Around 70 participants met digitally during a workshop on early detection and diagnosis of lung cancer hosted by Vision Zero cancer. The realization of a national implementation study for a screening program combined with smoking cessation, health informants, lung health checks, biomarkers, advanced imaging, apps and risk assessment tools based on AI in primary care, were some of the ideas that came up.

Lung cancer causes symptoms that come up late in the course of the disease and assessments are complicated. This means that half of the patients have a spread disease at diagnosis. At the same time, the general public and primary care can become better at paying attention to early symptoms, which can easily be confused with other conditions. With new systems and knowledge, we can pick up on symptoms earlier and more quickly come to treatment. And get a better chance of reaching the ‘vision zero’ – that zero people will die as a result of cancer and that more people will live longer and better.

Detecting the cancer in stage 1 gives a two-year survival rate of 80 percent. In stage 4, the two-year survival rate is 10 percent.

The workshop began with insights on why early detection of lung cancer is important, what other countries do on the subject and which needs are prominent in primary care. We were also updated on the expected results of Region Stockholm’s planned pilot study on lung cancer screening in connection with mammography, research on how biomarkers can improve early detection of lung cancer and an exchange of knowledge with the UK. Moderator Lisa Kirsebom interviewed a panel of representatives from health care, government and politics about what is left to solve before a national screening program can become a reality in Sweden.

The participants were then divided into groups to discuss two questions. The first about what data and knowledge we need to foster moving forward. Among other things, the difficulties in finding the right people to screen were highlighted – in the Stockholm region pilot study there are only women, how do we reach men who smoke? And how do we reach newcomers from countries where smoking is more common than in Sweden and where authorities are viewed with scepticism?

– The group that smokes the most can be the hardest to get to participate in screening programs” says one workshop participant. We also need to reach out with information on quitting smoking. Health informants can build trust and find new ways to reach out. Here we can also collect the knowledge generated during this year with covid-19 – how we can overcome the barriers of language and culture.

The group that smokes the most can be the hardest to get to participate in screening programs” says one workshop participant. We also need to reach out with information on quitting smoking.

At the same time, about 15 percent of those who get lung cancer have never smoked. To find them, the health care system, especially within primary care, needs new tools and more support.

The second question regarded in which areas there are needs for strategic and targeted cooperation to detect lung cancer earlier. The discussions led to concrete proposals. An app that combines the patient’s self-perceived symptoms with the geographic presence of radon. The continued strengthened research on radiology and biomarkers were some proposals that came up. Several participants expressed the need and interest to cooperate in the realization of a national implementation study. Allow a number of demonstrative projects where strategies can be tested, some of the workshop participants highlighted e.g. screening, mobile screening, biomarker testing, ways to attract people to screening, collaboration with primary care, digital health surveys, health informants and more general lung health checks.

About 15 percent of those who get lung cancer have never smoked. To find them, the health care system, especially within primary care, needs new tools and more support.

Examples of other ideas highlighted were collaboration with schools/universities/employers both around prevention and early detection, cancer-certified health centres with special expertise on early detection and collaboration between primary care and the country’s diagnostic centre in case of diffuse symptoms.

We are all very aware that something must happen now. I believe a lot in modern technology, algorithms and so forth. And to get information to further this process – that we patients are allowed to record and document symptoms.

The issue of including patients in the development of models, not only via data but also via experience, also came up. The workshop ended with Karin Liljelund, patient representative and vice chairman of the Lung Cancer Association, pointing out that patients would like to share their data.
– I appreciate that we patients are invited. We are all very aware that something must happen now. I believe a lot in modern technology, algorithms and so forth. And to get information to further this process – that we patients are allowed to record and document symptoms.

Are you curious about the introductory insights?

The importance of early detection and diagnosis

Mikael Johansson, Associate Professor and Senior Physician Oncology at Norrland University Hospital, talked about the importance of early detection and diagnosis. Over half of all lung cancer cases are diagnosed at stage 4, when the disease is metastatic and incurable. Approximately 25 percent is diagnosed in stages 1 and 2, when it can be treated with surgery or precision radiation therapy.
– Detecting the cancer in stage 1 gives a two-year survival rate of 80 percent. In stage 4, the two-year survival rate is 10 percent. Lung cancer screening increases survival, Mikael says. Sweden urgently needs to implement screening of risk groups. But how do we reach them, how do we organize ourselves, how do we choose better audiences?

What does the rest of the world do?

Ebba Hallersjö Hult, Head of the innovation milieu Vision Zero Cancer, gave an outlook on the world. The United States and South Korea have introduced targeted screening programs. Canada and China also carry out studies and plans towards this. The UK has conducted several studies and tested strategies to find and reach the right people. In Norway, an implementation study will start in 2021 in which approximately 1,000 high-risk people will be screened. The focus is to build knowledge about cost-effectiveness of lung cancer screening. Denmark is considering launching a small-scale screening program to map the impact on capacity needs in subsequent diagnostics. There too is a big ongoing discussion about how best to reach the risk group. In the EU, Croatia, a high-incidence country, has begun implementation. Also underway are a lot of exiting steps taken in the EU within the study 4-IN-THE-LUNG-RUN. The Study, within the Horizon 2020 programme, evaluates different strategies for lung cancer screening in 2020-2024. The study involves medical research institutions from Holland, Germany, England, France, Spain and Italy.
– Sweden is timely with discussions, research and studies. Now is the time to take it further, Ebba concludes.

Decision support in primary care to detect lung cancer earlier

It is a challenge to find patients who have cancer among all those who seek medical treatment within primary care, says Elinor Nemlander, General Practitioner at Sophiahemmet Primary Care Center and PhD student at Karolinska Institutet. In primary care, symptoms that may exist due to cancer are common. Coughing is the fourth most common cause for visiting. Elinor Nemlander believes in risk assessment tools, which can help primary care detect the right patients. For this, primary care-based clinical research is needed on the predictive value of symptoms, which is exactly the research that Elinor is undertaking.

Pilot study and cost-effectiveness of lung cancer screening in conjunction with mammography

Screening can require significant resources if the precision in the selection of people to screen is not accurate. The Stockholm-Gotland region has investigated the interest in and cost-effectiveness of lung cancer screening. In the pilot project, 1,727 women were asked questions about smoking habits and health at their mammography screening. 90% said they were also interested in lung cancer screening. Based on this, IHE calculated that lung cancer screening is cost-effective and lowers the mortality rate of patients 55-74 years of age. Telling us about this was Gunnar Wagenius, Senior Physician at Karolinska University Hospital and Chairman of the National Lung Cancer Registry, and Katarina Steen Carlsson, Associate Professor of Health Economics at Lund University and IHE.

Conclusions from expert meeting with England on lung cancer screening

Suzanne Håkansson, Senior Director Government Affairs, AstraZeneca AB and a member of Vision Zero Cancer’s core team shared words on a meeting and knowledge exchange held with British experts which Vision Zero cancer arranged earlier this autumn. Last year, the UK launched its Long-Term Cancer Plan, with a couple of quantitative targets. The NHS has encouraged development projects to contribute to the objectives. Here you will find more about the UK’s success factors for lung cancer screening.

Biomarkers to improve early detection of lung cancer

Mattias Johansson, PhD, Scientist, Genetic Epidemiology Group at the International Agency for Research on Cancer (IARC), talked about his research on how biomarkers can improve CT lung cancer screening. After a long study including 1 200 proteins, he and the research team have scaled down the work to seven biomarkers. These can significantly improve prediction, compared to a standard risk model based on smoking data. The study is ongoing.
– Next year we will try to validate the panel. In a year and a half, we hope that we will have a usable tool to really improve the inclusion criteria and follow-up process.

Panel discussions on issues left to solve and what obstacles to overcome

After the introductory talks, the moderator Lisa Kirsebom, science journalist and natural scientist, interviewed a panel consisting of Jan Nyman, Associate Professor andSenior physician Oncology at Sahlgrenska University Hospital and Chairman of the National Working Group for Lung Cancer, Mattias Fredriksson, Head of Unit responsible for national guidelines and screening at the National Board of Health and Welfare from the National Board of Health and Welfare, Jan Adolfsson, Associate Professor and Physician, Member of the National Screening Council and Camilla Waltersson Grönvall, Member of Parliament, Ordinary member of the Committee on Health and Welfare and spokesperson for the party Moderaterna.

Jan Nyman opens the discussion with stating that the screening population is set – 55-74-year-olds who are or have been heavy smokers. The question is now rather how to get them to come to screening. Mattias points out that other screening programs are often aimed at people who can be found using social security numbers. But now it is a group with a risk behaviour we need to find, they are not a given part of the population. In addition, about 15 percent of patients with lung cancer have never smoked. To find them, there must be other ways than screening.

Another aspect of establishing a screening program is how long it takes. Jan Adolfsson points out that the road to a national screening program is long. He compares it to mammography screening, which took 7-8 years to set up, and colorectal cancer screening, where the recommendation came in 2012 but implementation has not yet happened in many regions. From a political point of view, Camilla Waltersson Grönvall wants to see solutions move faster. For example, through more pilot studies, which Mattias Fredriksson welcomes. All initiatives are valuable and teach us more which moves us further towards making a final decision, he says.

Jan Adolfsson emphasizes that it is possible to start with efforts aimed at quitting smoking right away. And that it is the most cost-effective solution. At the same time, efforts are not mutually exclusive and can with advantage take place in parallel.

The panel agrees that the national perspective is important. Both for pilot studies, tools in primary care and for the possible screening recommendation.

How do we detect cancer earlier?

The earlier cancer is detected, the greater the chances of survival. With new systems and knowledge, we can catch up on symptoms earlier and more quickly come to treatment. And get more chances to reach the vision of zero persons dying from cancer and more people living longer and better.

Early detection and diagnosis

HomeGP’s and PhD students – Elinor and Eliya are looking for ways to detect cancer earlier

GP’s and PhD students – Elinor and Eliya are looking for ways to detect cancer earlier

Coughing does not have to mean the same thing in primary care as in the office of the pulmonary oncologist. Research on cancer, and the standardised care pathways, are mostly based on set diagnoses and are mainly based on research done in secondary care. This became clear to General Practitioners Elinor Nemlander and Eliya Abedi – Sweden needs more primary care-focused research, based on symptoms and not diagnoses.

For almost every cancer diagnosis Sweden has a national standardized care pathway: what assessments should be done, what treatment can be given and a time frame for the time allowed to pass between suspicion and treatment. After its introduction in 2015, the expected impact in primary care was delayed. Perhaps precisely because the care pathway is based on diagnoses.
– Patients come to primary care with symptoms – not diagnoses, says Elinor Nemlander. If you cough at a pulmonary oncological clinic, the probability that the cough is due to lung cancer is quite large. Coughing is one of the most frequently diagnosed symptoms in primary care, but a GP doesn’t even see one new lung cancer patient a year. It is not always the case that symptoms that are predictive of cancer in secondary care are equally predictive of cancer in primary care.

Patients come to primary care with symptoms – not diagnoses.

Elinor and Eliya have been working since 2017 with adapting the standardized care pathways and educating health care personnel as part of the knowledge team CaPrim – an abbreviation of cancer in primary care. CaPrim is part of Academic Primary Care Center – a joint venture between Stockholm Health Care Region, Karolinska Institutet and other partners for education, research and development for students and healthcare professionals working in primary care.

Earlier this year, Elinor and Eliya were enrolled as PhD students at Karolinska Institutet. They will research on precisely how cancer can be detected earlier in primary care. Elinor’s focus is on what symptoms may indicate cancer.
– The research so far has largely looked back at patients with cancer diagnosis in secondary care and what symptoms they had before diagnosis. But there is limited research on those seeking for the same symptoms in primary care. For example, how predictive is anemia for cancer in primary care?

Elinor will also investigate combinations of factors that may indicate lung cancer in patients who have never smoked. These may include factors such as symptoms, findings during assessments, lifestyle and other diagnosed disease. Finding the right combinations is crucial.
– We should not fail to detect those who have cancer, but we cannot investigate everyone with symptoms. There are also risks associated with over-investigation, such as unnecessary anxiety for the patient, neglect of other possible care and increased costs of care. We need to find ways to detect the right people to further assess. This can be done with IT support and risk assessment tools which, for example, could find the combinations that increase the risk of cancer.

We should not fail to detect those who have cancer, but we cannot investigate everyone with symptoms.

When it comes to risk assessment tools, the UK often comes up as an example.
– Unfortunately their health care system is divided in a different way than ours, so we can’t use their model outright. Much of what is done in primary care here is done in secondary care there. Eliya will do more research on risk assessment tools, looking specifically at colorectal cancer.

In Sweden, between 70 and 85 percent of patients, who later turn out to have cancer, start their investigation within primary care. But often it takes a long time and numerous visits before the diagnosis is made. Most reports of diagnostic errors related to primary care regard delayed or lack of cancer diagnosis.
– Eliya will look at whether an increased number of visits to primary care in a short period of time is predictive of cancer.

Elinor and Eliya spend half of their time on their PdD positions. The other half of their working hours, they work as general practitioners.
– This means that we have contact with the operational work on the floor in a different way, that we are clinically active. We hope that our research can contribute with scientific input to risk assessment tools that we and our colleagues can then use in our daily work.

Why has there been so little research in primary care so far? Elinor believes it is due to a lack of economic preconditions and time. The proportion of research funding going to primary care is small. There’s so much to do at the clinic that it’s hard to keep up with anything else. And also the very breadth of topics to target. It is not easy to find someone who works in primary care, who wants to do research and is interested in cancer.
– Actually, I ended up here mostly by accident. It started with my being involved in management work during my duties as specialist. That’s where I was recruited into CaPrim. That I chose to start researching was because of CaPrim. It became clear that this is research that is lacking and needed.

How do we detect cancer earlier?

The earlier cancer is detected, the greater the chances of survival. With new systems and knowledge, we can catch up on symptoms earlier and more quickly come to treatment. And get more chances to reach the vision of zero persons dying from cancer and more people living longer and better.

Early detection and diagnosis

HomeLung cancer screening – what are the success factors in the UK?

Lung cancer screening – what are the success factors in the UK?

Cervical cancer, colorectal cancer and breast cancer are examples of cancers that are often detected early through screening. It saves hundreds of lives every year. Can screening work for lung cancer? The UK has tested. To learn from their projects, results and thoughts, we met in a digital conversation.

To improve early cancer diagnosis, outcomes and care for patients, Sweden is looking into the potential of introducing a national screening program for lung cancer. The UK has already carried out several projects and studies on lung cancer screening. At the end of September, we got to share their lessons from healthcare, universities and medical technology companies, as part of the work to see if a national screening program for lung cancer can fit into the Swedish context.

Dr. Philip Crosbie, Manchester University, shared words about a project in Manchester where they came to the realization, through a survey, that patients found it impractical to visit the clinic. Therefore, they introduced a screening bus to take the service directly to the patient.

Professor David Baldwin, of the East Midlands Cancer Alliance, told us how they found and contacted hard-to-reach patients – a combination of mobile screening and phone contact. He emphasized governing protocols as a prerequisite for uniform and standardized care. Baldwin also highlighted the importance of advisory committees and learning from each other.

Another UK project, in which the National Health Service, Oxford University and actors from the life science industry work together, is exploring how AI can diagnose lung cancer more accurately and quickly. And at the same time reduce the amount of invasive procedures. Algorithms become health care.

Professor Annie Mackie, Public Health England, described how the UK envisions a national screening programme for lung cancer. Now, with more evidence from published studies in the Netherlands and the US showing that targeted screening is effective against lung cancer, they are discussing a policy change – but there are still a lot of questions that need answers. How to choose which people to screen? Which ethical considerations must be taken? How will the screening be built up?

The Swedish researcher Mattias Johansson shared a research group’s work at the International Agency for Research on Cancer using biomarkers as a model to find the right patients. For example, if the screening only involves smokers, a large group of patients are overlooked. The future goal is to be able to predict risks using proteins, as a complement to risks detected via questionnaires.

The success factors from the UK can be summed up by the facts that care should be available to the needs of the citizen and the patient, that collaboration between clinics, research and other stakeholders is needed, and that digital tools can make healthcare more efficient. Lung cancer screening works, but must be properly implemented to deliver results, be effective and save lives.

More about the workshop

The experience exchange agenda

Experiences of lung cancer screening studies, potential new technologies for early detection and the UK National Screening committee views on a population screening programme for lung cancer.

The participants in the experience exchange

Experts from Great Britain and Sweden met online.

How do we detect cancer earlier?

The earlier cancer is detected, the greater are the chances of survival. With new systems and knowledge, we can pick up on symptoms earlier and more quickly come to treatment. And get more chances to reach vision zero.