Lung cancer. Screening includes smokers and ex-smokers

Lung cancer screening will cover smokers and ex-smokers aged 55 to 74, who have smoked a pack a day for 20 years, in pilot projects starting in the Lisbon and North regions, announced the DGS.

"It's not a screening for the entire population of a certain age group, like, for example, colon and rectal cancer screening; it's for a population at risk," Deputy Director-General of Health André Peralta Santos told Lusa on World Lung Cancer Day.

Peralta Santos highlighted that lung cancer is the fourth most common malignant tumor in Portugal, with around 5,000 new cases detected annually and around 4,000 people dying from this disease.

Given this reality, he highlighted the importance of Portugal and other European Union countries testing lung cancer screening for the first time "using a relatively common test, a low-dose chest CT scan."

According to the Deputy Director-General of Health, people to be screened are between 55 and 74 years old, "are smokers or have stopped smoking less than 10 years ago and have smoked a pack a day for at least 20 years."

The DGS states in its guidance “Pilot Projects for Lung Cancer Screening,” which Lusa had access to, that “there is no good scientific evidence on the benefits or risks of continuing lung cancer screening programs for people at high risk” over the age of 74.

Those who are screened and test negative will be reevaluated annually . Positive cases will need to be referred for a specialist appointment within 30 days to properly diagnose "any potential problems."

"In cases where there is a lack of adherence to the diagnostic plan, after a positive primary screening test, due to failure to adhere to three appointments" for consultation at the screening unit, this should be classified as loss of follow-up and an alert generated for the person's family health team to outline personalized health care, the guidance reads.

André Peralta Santos explained that the screening will initially be launched in pilot projects to clarify operational issues, such as how many invited people will actually take the test.

"There are many operational aspects that we don't know about, and when we launch a population strategy, we want it to get off to a good start and for the Portuguese to have confidence in the entire process, from the moment they are contacted and invited for screening, until they are eventually followed up for their illness," he explained.

To do this, it is necessary to understand how many people invited will actually participate in the screening, as well as how many professionals are needed to operate the screening and treat people identified with lung cancer.

“One of the ethical imperatives of screening [is that] we cannot begin screening if we are not absolutely certain that we have sufficient resources to treat all the people who are identified,” he stressed.

An official source from the Ministry of Health revealed to the Lusa news agency that two pilot projects are underway, one at the Santo António Local Health Unit, in Porto, and another in the municipality of Cascais promoted by the municipality .

When asked when the pilot projects will begin, André Peralta said they will move forward next year . "We need a year for the pilots to be fully operational, and then we will evaluate [in 2027] and understand how we can scale this strategy to the entire population."

But he reinforced: “When we launch the strategy extended to the entire country (…) the Portuguese must have the security that when they are invited for a screening, they will have all the follow-up planned until the end”.

" For the first time, we have a measure that helps us reduce mortality from lung cancer , which is very deadly," he said, highlighting that studies indicate that, when screening is fully implemented, it can prevent between three and six deaths for every 1,000 people screened .

Lung cancer screening has long been advocated by the Portuguese Association for the Fight Against Lung Cancer and specialists to reduce the high mortality rate, which is a result of many diagnoses being made late.

"We are now ready to launch this pilot lung cancer screening project," said Rui Medon, clinical director of primary health care at the Santo António Health Unit (ULS de Saúde de Santo António), on World Lung Cancer Day. The project is currently in the equipment acquisition and installation phase, which should be completed by the end of the year, Medon said, adding that an imaging unit will be established at Magalhães Lemos Hospital, where screenings will take place.

At the same time, the training of diagnostic and therapeutic technicians, family doctors, and nurses will be updated, requiring them to pay "extra attention" to their existing work in identifying smokers and their smoking habits and helping them quit. There will also be a short period of testing and fine-tuning of "the entire system," and, he revealed, "in principle, during the first quarter of 2026, we will begin lung cancer screening."

The screening target population is between 55 and 74 years old with "high-risk criteria," namely "significant cumulative smoking habits" or who have quit smoking in the last 10 years. According to the official, this population is identified in the computer systems of family health units, through records kept by family doctors and nurses.

Regarding the number of people covered, he said the figures are still "very preliminary," but indicated that, at the Santo António Health Unit, there are approximately 93,000 people in this age group, of which an estimated 20% are smokers. "We expect the number to be screened to never exceed 18,000 people," he said. The pilot project will last at least one year, during which interim assessments and an annual evaluation will be conducted, based on previously defined operational and quality indicators, providing "a wealth of information" for making any necessary adjustments.

In Cascais, screening will be promoted by the Cascais City Council and is expected to begin this year, its mayor, Carlos Carreiras, announced to Lusa. The mayor estimated that the first screenings will begin later this year and will be conducted in a mobile unit that will visit "every location in the municipality," with an investment in equipment estimated at around two million euros.

"We learned from Covid-19, when it came to testing, that we have to reach out to the population and, preferably, at the neighborhood level to get greater citizen adherence," he stressed, recalling that the municipality already carries out other screenings such as breast cancer, together with the League Against Cancer, HIV, Hepatitis C and syphilis. Carlos Carreiras said that, although adherence to breast cancer screening is below 15%, he hopes to reach 50% adherence for lung cancer screening.

Cascais has approximately 54,000 inhabitants between the ages of 55 and 74, of which approximately 9,000 are considered high-risk smokers. The expectation is to cover approximately 4,500 people per year in the screening program developed in conjunction with the Ministry of Health. "The success of this project will depend largely on the participation of the citizens themselves," he emphasized, reinforcing the importance of detecting the disease early.