RESUMEN
BACKGROUND: Lung cancer screening in high-risk population increases the proportion of patients diagnosed at a resectable stage. AIMS: To optimize the selection criteria and quality indicators for lung cancer screening by low-dose CT (LDCT) in the Czech population of high-risk individuals. To compare the influence of screening on the stage of lung cancer at the time of the diagnosis with the stage distribution in an unscreened population. To estimate the impact on life-years lost according to the stage-specific cancer survival and stage distribution in the screened population. To calculate the cost-effectiveness of the screening program. METHODS: Based on the evidence from large national trials - the National Lung Screening Trial in the USA (NLST), the NELSON study, the recent recommendations of the Fleischner society, the American College of Radiology, and I-ELCAP action group, we developed a protocol for a single-arm prospective study in the Czech Republic for the screening of high-risk asymptomatic individuals. The study commenced in August 2020. RESULTS: The inclusion criteria are: age 55 to 74 years; smoking: ≥30 pack-years; smoker or ex-smoker <15 years; performance status (0-1). The screening timepoints are at baseline and 1 year. The LDCT acquisition has a target CTDIvol ≤0.5mGy and effective dose ≤0.2mSv for a standard-size patient. The interpretation of findings is primarily based on nodule volumetry, volume doubling time (and related risk of malignancy). The management includes follow-up LDCT, contrast enhanced CT, PET/CT, tissue sampling. The primary outcome is the number of cancers detected at a resectable stage, secondary outcomes include the average cost per diagnosis of lung cancer, the number, cost, complications of secondary examinations, and the number of potentially important secondary findings. CONCLUSIONS: A study protocol for early detection of lung cancer in Czech high-risk asymptomatic individuals (ELEGANCE) study using LDCT has been described.
Asunto(s)
Enfermedades Asintomáticas , Detección Precoz del Cáncer/métodos , Neoplasias Pulmonares/diagnóstico , Anciano , Enfermedades Asintomáticas/economía , Biopsia/economía , Biopsia/métodos , Análisis Costo-Beneficio , República Checa , Detección Precoz del Cáncer/economía , Femenino , Humanos , Pulmón/patología , Neoplasias Pulmonares/economía , Neoplasias Pulmonares/etiología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias/economía , Estadificación de Neoplasias/métodos , Selección de Paciente , Tomografía Computarizada por Tomografía de Emisión de Positrones/economía , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Estudios Prospectivos , Años de Vida Ajustados por Calidad de Vida , Pruebas de Función Respiratoria/economía , Pruebas de Función Respiratoria/métodos , Medición de Riesgo/economía , Medición de Riesgo/métodos , Factores de Riesgo , Tomografía Computarizada por Rayos X/economía , Tomografía Computarizada por Rayos X/métodosRESUMEN
Diphtheria, tetanus and pertussis are very serious diseases threatening the lives of children and adults. However, these diseases are preventable by vaccination. After the World Health Organization was founded in 1946, its experts rapidly developed a vaccination schedule for the pediatric population. The former Czechoslovakia, a founding member of this organization, actively participated in the implementation of vaccination against many infectious diseases, including vaccinations against tetanus, diphtheria and pertussis. Mass vaccination of children could not be implemented in all countries of the European Region. The main problem was differences in the economic situation since the mass vaccination of the pediatric population represents a significant financial burden. It was only in the early 1970´s that the pediatric immunization program was initiated in developing countries. The article compares the impact of vaccination in different continents (Europe, Asia, Africa) since 1980. High immunization coverge is essential for a reduction in the incidence of the above infectious diseases. Cases of the diseases reported between 1980 and 2016 are cited in the article. Trends in these infectious diseases are related to the economic and political changes that occurred at the turn of the millennium.