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 Följ länk

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
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Estonia-Sweden workshop on cancer – improving health outcomes through innovation and collaboration

The aim of Europe’s Beating Cancer Plan is to tackle the entire disease pathway. Over the coming years, it will focus on research and innovation, tap into the potential that digitalisation and new technologies offer, and mobilise financial instruments to support Member States. With its policy objectives, supported by ten flagship initiatives and multiple supporting actions, the Cancer Plan will help Member States turn the tide against cancer. Sweden and Estonia have decided to join forces in this endeavour.

On the 26th of May North Estonia Medical Centre Regionaal Haigla and Vision Zero Cancer arranged an interactive meeting to share experience and explore areas for collaboration in research and innovation to deliver on the mission of beating cancer. The meeting was focused around five key areas presented after the shared introduction by Dr. Terje Peetso (MD, Member of the Board at North Estonia Medical Centre) and Ebba Hallersjö Hult (Head of Vision Zero Cancer).

Bettina Ryll (MD, PhD, member of the Horizon Europe Mission Board for Cancer, Chair ESMO Patient Advocacy Group, Founder Melanoma Patient Network Europe) shared her thoughts on the emergence of A new era in cancer care in Europe followed by Professor Hans Hägglund (MD, Professor, National Cancer Coordinator, Chairman of the Federation of Regional Cancer centres, Chairman of Vision Zero Cancer) who painted the picture of the Swedish setting of 10 years with a national strategy – achievements and future outlook complemented by Dr. Vahur Valvere (MD, PhD, Director of Research and Development, North-Estonian Regional Hospital Cancer Center, Chairman of the Board of Estonian Cancer Society) giving the outlook of the Estonian National Cancer Control Plan for 2021-2030.

Mia Rajalin (PhD., lic. psychologist, Director of Studies, Region Stockholm, Member of the Board, the Swedish Lung Cancer Association and Vision Zero Cancer) member of the Vision Zero Cancer core-team and lung cancer patient gave her story of how the diagnosis became a driver for improving cancer care. The case of lung cancer was further elaborated by Dr. Simon Ekman (MD, PhD, Associate Professor, Senior Consultant, Department of Oncology-pathology, Karolinska University Hospital and Karolinska Institutet) and Dr. Kersti Oselin (MD, PhD, Medical Oncologist, North-Estonian Regional Hospital Cancer Center) sharing experiences from the Swedish Precision treatment of lung cancer at Karolinska Comprehensive Cancer Center and Estonian work with AI for early detection and prognostic significance of genomic markers in lung cancer recurrence.

Anu Planken (MD, PhD, Medical Oncologist, North-Estonian Regional Hospital Cancer Center) presented an Overview of the personalised oncology landscape in Estonia building on the promise of personalized medicine for cancer prevention, diagnosis and treatment.  Complementing this with the perspective of data and information-sharing Arvid Widenlou Nordmark (Coordinator National Quality Registries for Cancer, Confederation of Regional Cancer Centres) gave the Swedish view of how national quality registries are used to guide and evaluate clinical improvement efforts and introduced the The Patient Overview – an enabler for personalised medicine. Rounding up the group of speakers was Dr. Indrek Seire (MD, Surgical Oncologist, North-Estonian Regional Hospital Cancer Center) giving an oversight of the Estonian work with Structured health data and site-based databases in oncology. 

The meeting continued with the approximately 25 participants being split into breakout groups discussing the question of how we can leverage the promise of personalised medicine (PM) for our patients and societies? with the goal of both sharing knowledge and insights while strengthening possibilities for successful international collaborations.

The successful outcome of the meeting has led to a deepened collaboration within cancer care between Sweden and Estonia with planned visits and experience exchanges on site in Sweden during the autumn 2021 and in Estonia in the spring of 2022.  

Watch the recorded meeting.

Meeting agenda Följ länk

North Estonia Medical Centre Regionaal Haigla and the Swedish Innovation Milieu Vision Zero Cancer held an interactive meeting to share experiences and explore areas for collaboration in research and innovation to deliver on the mission of beating cancer.

What we innovate

Fewer people shall get ill and die from cancer. For that to work, we need to think in new ways. Both in terms of developing new solutions and getting better at using what is available.

Five areas that need renewal
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This is Vision Zero Cancer

Vision Zero Cancer challenges the prevailing ecosystem and connects new ones. We are going to turn cancer from a deadly into a curable or chronic disease.

Who we are
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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 Följ länk

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 Följ länk

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.

Early detection and diagnosis
Follow link