Stang and co-authors present model calculations, based on the data of the US National Lung Screening Trial, of the expected effects of introducing lung cancer screening with low-dose computed tomography (CT) nationwide in Germany (1). With an estimated 3.9 million CT scans to be performed over three years, more than 900 000 tests would show suspicion of tumor, approximately 3% of which would be positive, such that their premature discovery would prevent about 4000 deaths from lung cancer. Thus, each confirmed case would be associated with about 30 false alarms, and about 1000 CT scans would be needed to prevent one lung cancer death. The expected cost-effectiveness would be very low.
In comparison, a recently published modelling study of the expected effects of the first 10 years of screening colonoscopy in Germany showed that about 4.4 million screening colonoscopies prevented more than 180 000 cases of colorectal cancer and detected a further 40 000 cases of colorectal cancer in early, and usually well curable, stages (2). This highly cost-effective—if not cost-saving (3)—screening thus prevented about 80 000 cancer deaths.
While the projected numbers of these studies may be subject to uncertainties (which is inevitable with modelling studies), they are most valuable to assess the magnitude of the expected effects in relation to the necessary resources. Such an assessment is required for health policy decisions be made on an epidemiologically substantiated basis.
It would be highly desirable that, also in Germany, substantiated modelling and simulation studies would be requested, funded, professionally carried out, and used for health policy decisions and prioritizations. This has long been the scientific and public health standard in other countries, thereby helping to avoid flying blind in cancer prevention (4).
Footnotes
Conflict of interest statement
The authors declare that no conflict of interest exists.
References
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