OBJECTIVES: Lung cancer is the most common type of cancer diagnosed in Greece, accounting for 13.9% of total new cancer cases and, by far, the biggest cancer-related killer (23.1% of deaths) (Globocan, 2020). Despite this high epidemiological burden, the country does not implement a national lung cancer screening strategy. This study estimates the impact on lung cancer life years (LCLYs) of a hypothetical scenario, where 100% of high-risk population, as defined by the US Preventive Services Taskforce (2021), i.e., aged 50-80, firsthand (20 pack-years) or ex-smokers (quit within the past 15 years) are screened and linked to care (SLTC) for lung cancer versus the current scenario of opportunistic screening in Greece.

METHODS: A stochastic model was built to monitor a hypothetical cohort of 100,000 high-risk men and women as they transitioned between health states (without cancer, with cancer, alive, dead) over 5 years. Transition probabilities were based on clinical expert opinion. Expected outcomes (cancer cases, cancer-related deaths and LCLYs lost) were modelled in both current and hypothetical scenarios. The difference in outcomes between the two scenarios was calculated. 150 iterations of simulation scenarios were conducted for 100,000 persons each and means and standard deviation (SD) calculated.

RESULTS: Over 5 years, the hypothetical scenario leads to fewer deaths (-24.56%, p<0.001) and less life years lost (-31.01%, p<0.001). It also leads to a shift to lower-stage cancers at the time of diagnosis – this allows for more frequent eligibility for curative treatment. Our findings, derived from a stochastic model based on clinical expert opinion, are in line with the recently published outcomes of the NELSON clinical trial (de Koning et al, 2020).

CONCLUSIONS: Our study suggests that applying a 100% screening strategy amongst high-risk adults aged 50-80, would result in additional averted deaths and LCLYs gained over 5-years in Greece.