Screening for lung cancer

The Health Council of the Netherlands advises to further work out what a possible national population screening programme for lung cancer could look like, so that it can be assessed whether the advantages outweigh the disadvantages.

In a national population screening programme, an unsolicited medical examination is offered to people who have no health complaints. The goal is to detect a certain disease at an early stage and thus achieve health gains. Participants of screening can benefit from this, but also experience disadvantages. To assess whether screening offered by the government is justified, the Health Council’s permanent committee on Population Screening assesses, before the introduction of the screening, whether the advantages outweigh the disadvantages. At the request of the Ministry of Health, Welfare and Sport, this has now also been done for a possible screening programme for lung cancer.

Based on the available scientific literature, the committee concludes that a screening programme could reduce mortality due to lung cancer, and possibly also general mortality. However, for several important disadvantages it is not yet possible to estimate the extent to which they will occur. This depends on the design of the screening programme, which is not clear yet. For instance, it is not yet known how often screening should take place and how the final diagnosis is made after an unfavourable test result (i.e. abnormalities that may indicate lung cancer). It is also not known how great the risk is that if the test result is unfavourable, it will not turn out to be lung cancer. In that case, someone has been unnecessarily worried and someone has undergone unnecessary follow-up examination. Also, it is not yet clear what happens if other conditions than lung cancer are detected (so-called secondary findings).

Considering these uncertainties, it is not yet possible to assess whether the advantages of a possible population screening programme for lung cancer outweigh the disadvantages. The committee advises the Ministry of Health, Welfare and Sport to have the screening programme worked out further, so that it can be re-assessed afterwards whether a population screening programme for lung cancer meets the criteria for population screening.