Can a National Lung Cancer Screening Program in Combination with Smoking Cessation Policies Cause an Early Decrease in Tobacco Deaths in Italy?

Abstract

Objective is to predict smoking attributable deaths (SAD) for lung cancer and all causes in Italy, 2015 to 2040, assuming a yet unimplemented tobacco control policies (TCP) and a national, low-dose, lung cancer, computed tomography (CT) annual screening program (CT screen).A dynamic model describing the evolution of smoking habits was developed to estimate quit rates, 1986 to 2009, and to predict SAD under different scenarios: keeping the status quo; raising cigarette taxes by 20%; implementing cessation treatment policies (funding treatment, setting up an active quitline, promoting counseling among health professionals); introducing a three-round annual CT screen for current and former heavy smokers aged 55 to 74, 70% compliance, 20% lung cancer mortality reduction; combining all the above-mentioned measures.The CT screen brought a 3.0% constant annual reduction in lung cancer SAD and decreased or postponed all-cause SAD by 1.7% annually (a half due to respiratory diseases), relative to the status quo scenario. The effect was noticeable after few years from its introduction. TCP showed a steadily strengthening effect starting from 5 to 10 years after implementation. The lung cancer and all-cause SAD under cessation treatment policies, for instance, were reduced by 8.4% and 12.0% in 2030, respectively, and by 16.1% and 20.0% in 2040. TCP gave a greater effect than CT screen in reducing all-cause SAD because cessation brought about a reduction in smoking-related SAD other than lung cancer and respiratory diseases.Combining TCP and CT screen could bring about an early decrease in lung cancer and respiratory disease SAD due to CT screen, followed by a more substantial drop in all-cause SAD in subsequent decades due to TCP. Cancer Prev Res; 5(6); 874-82. Ó2012 AACR.

Is 20% of a loaf enough?

“…3 We recently published an article on predictions of LCDs and all-cause deaths in Italy assuming yetunimplemented tobacco control policies (TCPs) with or without a national lung cancer screening program designed with the same regimen adopted in the National Lung Screening Trial. 4 Similar to Ma et al, 2 we estimated that a lung cancer screening program implemented in 2015 in Italy with a 70% uptake would bring a 3% constant annual reduction in LCDs, with approximately 700 avertable LCDs each year. We estimated that implementing a screening program in combination with TCPs would yield 2881 and 4824 avertable LCDs in 2030 and 2040, respectively.…”

All‐cause mortality versus cancer‐specific mortality as outcome in cancer screening trials: A review and modeling study

“…Out of the seven modeling papers, three investigated lung cancer screening with CT, two mammography screening, one FOBT testing, and one mammography and sigmoidoscopy (Table ). Four papers used a simple mathematical calculation to estimate the effect of screening, one used a Markov model, one applied patient level microsimulation, and in one case the study design was not clear.…”

A compartmental models for smoking dynamics in Italy: A pipeline for inference, validation, and forecasting under hypothetical scenarios

“…where ω 0 governs the lifetime probability of no relapse and ω 1 tunes how fast the rate of smoking relapse declines with the time from cessation [12,23,28,34]. Both ω 0 and ω 1 are assumed to be positive so that η * (c) is a positive, decreasing function of c. The assumptions on which the SHC model is based are summarized in Section Model assumptions, Supplemental Material.…”

“…It is worth noting that in the GSA we did not include the age-specific mortality rates, δ pop (t; a), among the model inputs. It is reasonable, as done elsewhere [23], to treat these parameters as not affected by uncertainty, given that they were estimated based on the entire population.…”