Challenges of Implementing Lung Cancer Screening in a Developing Country: Results of the Second Brazilian Early Lung Cancer Screening Trial (BRELT2)

Abstract

PURPOSE This paper aims to present the results of a series of several Brazilian institutions that have been carrying out lung cancer screening (LCS). MATERIALS AND METHODS This is a retrospective, cohort study, with follow-up of individuals of both sexes, with a heavy smoking history, who participated in LCS programs between December 2013 and January 2021 in six Brazilian institutions located in the states of São Paulo, Rio Grande do Sul, and Bahia. RESULTS Three thousand four hundred seventy individuals were included, of which 59.8% were male (n = 2,074) and 50.6% were current smokers (n = 1,758), with 60.7 years (standard deviation 8.8 years). Lung-RADS 4 was observed in 233 (6.7%) patients. Biopsy was indicated by minimally invasive methods in 122 patients (3.5%). Two patients who demonstrated false-negative biopsies and lung cancer were diagnosed in follow-up. Diagnosis of lung cancer was observed in 74 patients (prevalence rate of 2.1%), with 52 (70.3%) in stage I or II. Granulomatous disease was found in 20 patients. There were no statistical differences in the incidence of lung cancer, biopsies, granulomatous disease, and Lung-RADS 4 nodules between public and private patients. CONCLUSION There are still many challenges and obstacles in the implementation of LCS in developing countries; however, our multi-institutional data were possible to obtain satisfactory results in these scenarios and to achieve similar results to the main international studies. Granulomatous diseases did not increase the number of lung biopsies. The authors hope that it could stimulate the creation of organized screening programs in regions still endemic for tuberculosis and other granulomatous diseases.

Lung cancer screening with low-dose CT integrated with pulmonary care in a public hospital in southern Brazil: results from the first 712 patients

“…(17,18) No entanto, estudos como o de Santos et al (19) demonstram que as taxas de detecção de câncer e a necessidade de exames invasivos podem ser semelhantes às em países desenvolvidos. De fato, em um estudo recente de Hochhegger et al, (20) que avaliou retrospectivamente os resultados de rastreamento de 3.470 pacientes no Brasil (88% no sistema privado de saúde), os resultados foram bastante animadores: a prevalência de câncer foi de 2,1% e, mais importante, o estadiamento precoce foi identificado em 70,3% desses casos. Esses resultados são semelhantes aos em estudos internacionais, e os autores concluíram que a prevalência local de doenças granulomatosas não aumentou o número de biópsias pulmonares.…”

“…Esses resultados são semelhantes aos em estudos internacionais, e os autores concluíram que a prevalência local de doenças granulomatosas não aumentou o número de biópsias pulmonares. Os resultados do nosso estudo vão na mesma direção e aumentaram significativamente o número de pacientes rastreados no sistema público de saúde (401 em Hochhegger et al (20) vs. 721 no presente estudo). Mesmo com as limitações inerentes ao contexto do sistema público de saúde, nossas taxas de estadiamento precoce foram semelhantes às de Hochhegger et al (20) -64,3% vs. 70,3% -o que representa um avanço muito importante em relação às taxas usuais sem rastreamento.…”

“…Os resultados do nosso estudo vão na mesma direção e aumentaram significativamente o número de pacientes rastreados no sistema público de saúde (401 em Hochhegger et al (20) vs. 721 no presente estudo). Mesmo com as limitações inerentes ao contexto do sistema público de saúde, nossas taxas de estadiamento precoce foram semelhantes às de Hochhegger et al (20) -64,3% vs. 70,3% -o que representa um avanço muito importante em relação às taxas usuais sem rastreamento. Acreditamos que a expertise de centros acadêmicos ou de grande volume em um contexto multidisciplinar, com especialistas familiarizados com a epidemiologia local e o manejo de doenças granulomatosas, pode contribuir para resultados satisfatórios como os obtidos no presente estudo, sem investigações desnecessárias.…”

Implementation of an Integrated Lung Cancer Prevention and Screening Program Using a Mobile Computed Tomography (CT) Unit in Brazil

“…12 - 17 However, lung LDCT screening in Brazil is still in its early steps; it is composed of sparse initiatives and is not widely available in the public setting. 18 …”

Investigation on the incidence and risk factors of lung cancer among Chinese hospital employees

“…According to previous research reports, it is known that repeated LDCT screening in high-risk groups of lung cancer can effectively reduce the death of patients because of lung cancer to a certain extent. However, considering the epidemiological characteristics of lung cancer in different regions and the differences in the availability of medical resources, 19,[22][23][24][25][26] whether high-risk groups with different definitions can also benefit from one-time LDCT screening is an urgent scientific question that needs to be answered. [27][28][29][30][31] The effect of popularization of LDCT on the detection rate of lung cancer Chest X-rays are usually performed in routine physical examinations.…”