gms | German Medical Science

Background: Lung cancer is the leading cause of cancer-related death in men and the second leading cause in women. Two international studies have demonstrated the cost-effectiveness of lung cancer screening, with a reduction in lung cancer mortality of 9–14% and costs of $ 69.000–$81,837 per QALY. Ongoing studies in Germany have also shown initial results of a 15% reduction in lung cancer mortality. The German Federal Ministry for the Environment, Nature Conservation, Nuclear Safety and Consumer Protection (BMUV) is expected to introduce a legal framework for lung cancer screening in 2024. This would make unstructured lung cancer screening possible. A structured programme is expected to be introduced 18 months later.

Objective: The assessment of potentially involved physicians will be an important factor for the successful implementation of lung cancer screening. Therefore, the present study assessed the opinions and knowledge of the medical community regarding lung cancer screening.

Methods: The 24-question survey covered topics related to knowledge, acceptance and challenges of lung cancer screening. A total of 50 physicians in the field participated in the survey. The physicians represented all age groups, hierarchical levels and genders, as well as different specialties in the field.

Results: The study found high acceptance of lung cancer screening among physicians. Approximately 82% agreed that screening is an effective method for early detection and 86% supported nationwide implementation in Germany. In particular, 100% of physicians endorsed low-dose computed tomography (LDCT) as the preferred method. Already 32% have recommended lung cancer screening to their patients. Challenges and risks identified by physicians included reaching the target population (62%), quality assurance (48%), false-positive results (44%), health system burden (36%), lack of structure (18%), and lack of legal framework (10%). The main barriers reported were lack of legal framework (70%) and uncertain funding (26%). General practitioners (86%) and pulmonologists (78%) in particular should encourage patients to take part in the screening programme. From the physicians' point of view, inclusion in the programmes should be mainly through pulmonologists (66%).

Implication for research and/or (healthcare) practice: This study provides important insights into the design of a structured lung cancer screening programme from the perspective of participating physicians. It highlights the need for, and physician support of, the implementation of such a programme. The identified challenges and risks should be thoroughly discussed and considered in the development of screening guidelines and pave the way for a successful implementation of lung cancer screening, probably by 2025.