Health insurance will cover lung cancer screening: The HANSE study defines who should participate

The HANSE study demonstrates the feasibility of lung cancer screening using low-dose computed tomography (LDCT) in everyday medical practice. However, it is important to determine who would benefit from screening and who would not. In a scientific article recently published in Lancet Oncology, researchers of the German Center for Lung Research (DZL) describe how to better define the criteria for this.

More than 50,000 people in Germany are diagnosed with lung cancer every year. This makes the disease, also known as bronchial carcinoma, the third most common type of cancer in women and the second most common in men. The main cause of lung cancer is smoking. The longer and more intensely a person smokes, the higher their risk of developing lung cancer. Since symptoms often only appear at a late stage, the disease is frequently discovered, when it is often no longer easily treatable. However, if lung cancer is detected early, there is a good chance of successful treatment through surgery, immunotherapy or chemotherapy.

Clinical studies are investigating the effectiveness of CT screening for lung cancer

In recent years, several international studies have investigated the potential of lung cancer screening using computed tomography (CT) to facilitate earlier detection of the disease. These studies have sought to establish criteria for determining an individual’s risk of developing lung cancer. Those at high risk should participate in a screening programme if possible. For everyone else, the burden of a CT scan should be avoided. There is also the economic question of the effective use of screening measures.

How can we determine who would benefit from screening examinations?

This is where the HANSE study*, initiated by the German Center for Lung Research (DZL), comes in. In this study, researchers from the LungenClinic Grosshansdorf and the University Medical Center Schleswig-Holstein in Lübeck (both DZL sites ARCN) and the Hannover Medical School (DZL site BREATH), together with AstraZeneca, examined the feasibility, acceptance and effectiveness of lung cancer screening across Northern Germany. The focus was on high-risk patients: heavy active and former smokers aged 50–75. A total of 13,000 people completed a questionnaire which was used to calculate their risk level.  Of these, over 4,000 individuals from the high-risk group attended one of three study centres in northern Germany for a low-dose CT scan and a follow-up examination after one year.

The results of the HANSE study have been published

The study showed that there is generally great interest among the population in participating in a screening programme. In addition, lung cancer screening could easily be integrated into the daily medical routine of the three clinics. Initial results have already shown that structured screening can diagnose lung cancer significantly more often at an early, curable stage than conventional diagnosis after symptoms have appeared. These results have now been published in Lancet Oncology, one of the most renowned journals in the field of oncology, and go into even greater detail. The individualised risk model used, called PLCOm2012, achieved results seven times better than a more rigid classification based on age and smoking history. It was therefore more effective and efficient in detecting lung cancer.

Professor Martin Reck, Head of the Oncology Department at the LungenClinic Grosshansdorf, explains: ‘If we use the more comprehensive PLCOm2012 score with a defined threshold value, we have to screen about six per cent more people, but we detect significantly more cases of lung cancer. This makes screening more efficient, meaning fewer CT scans are required to diagnose one case of lung cancer.’

The next phase of the HANSE study is already underway

While the evaluation of the data continues, the next phase of the study is being launched, extending screening to people who were previously classified as low-risk patients. Study centres are also re-inviting some high-risk individuals for monitoring. Particular attention is being paid to integration into existing preventive care structures, digitising invitation and documentation processes, and evaluating additional risk factors such as genetic predisposition or environmental exposure.

LDCT lung cancer screening becomes a statutory health insurance benefit

Six months ago, HANSE reached an important milestone when it was recognised as one of the decisive studies that influenced the Joint Federal Committee (G-BA) to make early lung cancer screening for risk groups a new statutory health insurance benefit. The screening programme is expected to be implemented in April 2026. This is an excellent outcome for lung health in Germany.

 

*HANSE is the abbreviation for Holistic implementation study Assessing a Northern German interdisciplinary lung cancer Screening Effort

Source: Link to the article

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