Description:

Lung cancer still ranks first in Italy in terms of mortality, while it is the third in number of cases after colorectal and breast cancers. Survival at 5 years after diagnosis is just under 16% and is inexorably burdened by the fact that a large proportion of the diagnosis is made when the cancer is at an advanced stage.

An examination such as spiral CT scan could capture millimeter lesions that a surgical operation could remove, definitely improving the prognosis of the disease. And, this is the exam that should become part of the screening programs according to a risk stratification approach. The spiral CT scan is the only method supported by scientific evidence for the early diagnosis of lung cancer associated with a reduction in mortality. In Europe, the time is ripe to start a lung cancer screening program.

SMAC (Smokers health Multiple Actions) is a prevention program in Italy for smokers or ex-smokers whose objectives are testing a reliable method of recruiting a population at risk in collaboration with family doctors and integrate a prevention program of different smoking-related diseases of the respiratory system, primarily emphysema and COPD, but also those affecting the cardiovascular system, such as heart attack and stroke. The SMAC program involves the performance of some tests, including coronary calcium at low-dose CT scan and spirometry, antismoking activity. The program also plans to study molecules and blood cells in order to develop non-invasive methods for the early detection of tumors and to develop a computerized program for the automatic diagnosis of pulmonary nodules. The correct management of small nodules detected at screening is critical to avoid risk of overdiagnosis and reduce false-positive cases at surgery. In addition, surgical resection is becoming more and more conservative.

Learning Objectives:

•Understand indication to screening and selection of high risk individuals.

•Learn risks and benefits of LC screening.

•Understand the diagnostic algorithm to reduce false-positive cases.

•Learn stage distribution of screening cancers and indication to lung-sparing minimally invasive surgery.

Gerard A. Silvestri, MD, FCCP

Giulia Veronesi, MD

Learning Objectives:

•Review interesting complicated cases of lung cancer with an expert panel, including pulmonology, thoracic surgery, and interventional pulmonary medicine.

•Better understand, through case-based scenarios, how decisions are made with regards to the diagnosis, staging, and treatment of lung cancer.