The German Cancer Research Centre and the Thorax Hospital in Heidelberg work very closely together in the diagnosis, therapy and prevention of lung cancer. The two institutions have now started a screening intervention study, which is the German contribution to major multinational efforts towards a systematic early diagnosis of lung cancer.
In Germany, there are 46,000 new cases of lung cancer a year leading to 40,000 fatalities– a frightening situation. Worldwide, it is estimated that lung cancer kills 1.2 million people per year, a number that is increasing rapidly in many countries. Smoking has been identified as the number one cause of this high incidence and of the increase in lung cancer and the number of fatalities. Lung cancer only rarely affects people who have never smoked and who have never – at least knowingly – been exposed to harmful substances (for example asbestos fibres and radon radiation).
Lung cancer is the major cause of cancer-related deaths in men (28,820 cases); it is the third most frequent cause of cancer-related deaths in women (11,026) (figures of 2004; Krebsatlas GEKID, Gesellschaft der epidemiologischen Krebsregister (German Society of Population-Based Cancer Registries)). The number of men diagnosed with lung cancer has decreased over the last 20 years, but the figures for women have almost doubled over the same period of time - a deplorable result of the fact that women's consumption of tobacco has dramatically increased. Efforts by anti-smoking campaigns have at least led to modest successes in persuading men to give up. It is particularly alarming that many children and youngsters are heavy smokers, with many smoking their first cigarette when they are very young. It is imperative to raise awareness that smoking is anything but "cool" and is not a lifestyle drug, but an addiction which the majority of people are only able to quit with medical help.
In a population-based study, scientists in Professor Hermann Brenner's department at the German Cancer Research Centre (DKFZ) found that the majority of older smokers in Germany would like to stop smoking and have repeatedly tried to do so, albeit unsuccessfully. The DKFZ has set up a "Smoker's hotline" (0049-06221-42 42 00) to support smokers who want to stop smoking and also give information about therapists and hospitals to contact. The DKFZ also offers special advice (0049-06221-42 42 24) for cancer patients and their families on shaking off the smoking habit. It is never too late to stop smoking. Lung cancer patients stand to respond more effectively to cancer therapy once they have given up smoking.
The DKFZ and the Thorax Hospital in Heidelberg have been working together on lung cancer projects for quite some time. The Thorax Hospital, which is located in an idyllic area in Heidelberg-Rohrbach, is one of the oldest and largest lung specialist hospitals in Europe, treating around 5,000 inpatients and around the same number of outpatients every year.
With its service spectrum in the field of internal oncology, specifically thoracic tumours and thoracic surgery, the Thorax Hospital is a leader in its field in both Germany and Europe. The hospital is part of the National Centre for Tumour Diseases (NCT), in which the DKFZ and the University Hospital of Heidelberg and German Cancer Aid are also involved. A patient support group consisting of patients and their relatives was established at the Thorax Hospital to offer support to patients and their families. This support group is also involved in making the public at large aware of the disease and is working towards the implementation of measures in society as a whole that contribute to the more effective prevention of lung cancer, as well as earlier diagnosis and more effective treatment.
The DKFZ and the Thorax Hospital are carrying out a large study on the early diagnosis of lung cancer entitled LUSI (Lung cancer screening intervention study), with the future goal of being able to diagnose lung cancer earlier than is currently possible and improve the chances of cure. The study was initiated in September 2007. Up until mid 2009, 240,000 people between the ages of 50 and 69 (smokers, non-smokers and former smokers) from the Rhine Neckar area were invited to take part in a written survey. Around 4,000 people were subsequently selected to take part in a randomised study, which is funded in equal parts by the German Research Foundation (DFG) under its "Clinical Trials" funding programme and the Dietmar Hopp foundation in Walldorf.
"We hope that this study will provide us with information that will help us assess how suitable multislice computed tomography (ASCT) is for detecting lung cancer at a very early stage, which would thus enable effective treatment," said the leader of the study, Professor Nikolaus Becker, epidemiologist at the DKFZ. The problem is that lung cancer is normally only detected at an advanced stage, i.e. when effective treatment is no longer possible. This means that around 85 to 90 per cent of all lung cancer patients die within five years of diagnosis. If lung cancer is detected very early, patients' prospects are far better. Diagnostic methods such as lung X-rays or cytological sputum (excreted mucus of the respiratory tract) investigations have so far not proven to be effective in detecting early lung cancer. However, there is some evidence that MSCT is able to detect tumours very early on (in stage 1a).
The LUSI study is the German contribution to a multinational European study involving 28,000 people from Denmark, the Netherlands and Italy. It compares the effectiveness of MSCT with a control group. A large randomised study involving around 50,000 people is also being carried out in the USA, in which the diagnosis of lung cancer using MSCT is compared to X-ray images. The objective of this large international project is to find out whether MSCT is suitable for the systematic early diagnosis of lung cancer and whether it is able to reduce the mortality rate of study participants suffering from lung cancer by at least 20 per cent. Results are expected in about five to seven years.
The participants in the LUSI study also have a direct benefit. Smokers are given the option of attending a free consultation to help them shake off the habit. MSCT has already led to the discovery of lung cancer in a number of people in whom the disease was at a sufficiently early stage to allow effective treatment. Particularities were discovered in about 20 to 25 per cent of all those examined, which will be investigated further. In the majority of cases, the particularities have turned out to be harmless; however, the all clear can only be given after three to six months.