Lung cancer screening in Lebanon: Joint statement from the Lebanese Pulmonary Society and the Lebanese Society of Medical Oncology

Abstract

Lung cancer is the leading cause of cancer mortality worldwide. The 5-year survival rate of patients is ~15%, since the majority of patients present with the disease at an advanced stage. The resulting burden from this disease entails solid efforts towards early detection and smoking cessation. In Lebanon, the triad of high incidence and mortality from lung cancer, extensive tobacco consumption and delayed diagnosis calls for urgent actions. Furthermore, lung cancer screening with a low-dose computed tomog- raphy (CT) scan allows for the early detection and reduces mortality rates, as documented in several randomized trials and meta-analyses and recommended by international relevant societies. A panel of Lebanese lung cancer experts, members of the Lebanese Society of Medical Oncology and the Lebanese Pulmonary Society, have convened and discussed all aspects and challenges related to lung cancer screening implementation in Lebanon. Accordingly, national guidelines were proposed in this joint statement, which defines the particular high-risk population that would most benefit from screening. Pillars to success involve a solid, evidence-based national program, efficient smoking cessation programs and proper referral and follow-up. In parallel, the quality and logistical basic requirements must be optimized with well-equipped centers, trained personnel and expert radiologists; in addition to promoting awareness, adherence and sustainability. Physicians need to be trained to ensure accurate risk stratification for the screening and proper referrals from different specialties. Awareness should also be raised in the general population on the safety and benefits of low-dose CT, and to encourage smoking cessation via dedicated programs. In a country where the economic situation is challenging, and where third-party payers are resistant to cover screening initiatives, support from the Lebanese Ministry of Public Health is warranted, along with a cost-effectiveness analysis to uncover the elevated cost of treating advanced stage lung cancer.