Lung cancer is the leading cause of cancer-related deaths. Around 3,300 people die from it every year in Switzerland. Tobacco smoking is by far the leading risk factor for lung cancer, accounting for about 80-90% of lung cancer diagnoses. In view of the high burden of the disease, there is a national and international debate on whether low-dose CT (LDCT) screening for lung cancer should be offered to people at risk; defined as current and former smokers aged 55 and older.
Evidence Appraisal
The Swiss Cancer Screening Committee appraised the evidence on ethical issues for lung cancer screening, the clinical effectiveness as well as the cost-effectiveness and the budget impact. Using the method ‘GRADE Evidence to Decision (EtD) framework’, it formulated its lung cancer screening recommendation using low-dose computed tomography CT (LDCT) for Switzerland.
The Swiss Cancer Screening Committee’s Recommendation
The Swiss Cancer Screening Committee suggests offering low-dose computed tomography (LDCT) lung cancer screening to people at risk.
(GRADE conditional recommendation)
Reduction in Lung Cancer Deaths
The Swiss Cancer Screening Committee issued a conditional recommendation in favour of screening because LDCT lung cancer screening probably results in an absolute reduction of 43 lung cancer deaths per 10,000 persons over a 10-year screening period (moderate evidence). The overall number of deaths may be reduced by 36 per 10,000 people (low evidence). In addition, LDCT lung cancer screening may result to an increase in lung cancer stage I or II diagnoses (low evidence) and a small reduction in lung cancer stage III or IV diagnoses (low evidence).
This recommendation is centred on the individual perspective of people at risk. The Swiss Cancer Screening Committee thinks that a majority of informed high-risk people would consider screening.
Considerations for Implementation
The Swiss Cancer Screening Committee strongly recommends offering LDCT lung cancer screening within organised programs. Only an organised program can ensure an accessible and equitable offer of screening, as well as its quality. Moreover, a program would also allow the possibility of exemption from the deductible; an important prerequisite for equity of access.
Reaching the at-risk population is a central concern for which specific recruitment strategies and implementation approaches are required.
People at risk need to be supported in decision-making by appropriately trained health professionals (shared decision-making) so that each person can make a decision that is in line with his/her values, preferences and individual situation.
Participation in screening should be a free choice and non-participation should not have negative consequences, in terms of stigmatisation or exclusion from healthcare services.
Smoking cessation support based on the current state of knowledge should always be offered to persons at risk; regardless of their decision to undergo screening or not.
Further Information
Press release of 15 November 2022
Short version recommendation
Appraisal report Recommendation on low-dose CT screening for lung cancer Nov2022
Health Technology Assessment Low-dose CT screening for lung cancer (HTA report)
Stakeholder Konsultation zum “HTA report”
Scoping Report Low-dose CT screening for lung cancer October 2020
Stakeholder Consultation Scoping Report 20200511