After breast, colon and cervix, in the future oncological screening will also be extended to lung and prostate cancer, currently considered among the big killers in the population at risk. If for the first a dedicated experimental study on heavy smokers has already been started, for the second it is the European Community that recommends the adoption of diagnostic tests through the analysis of prostate specific antigen (Psa) in men up to 70 years of age. Mammography is life-saving, but it is necessary to promote its adherence, especially in the South. This is what emerged during the third day of the 51st National Congress of SIRM, the Italian Society of Medical Radiology, which brings together around 8 thousand clinicians at the MiCo in Milan.
“Lung cancer represents the third most frequent neoplasm in Italy, the second for men and third for women – explains Andrea Giovagnoni, president of Sirm – With an estimate of 44 thousand new diagnoses in 2023 and 35,700 deaths in 2022, it is today a of the most feared oncological pathologies. In recent years the incidence of this tumor in women has increased, thanks to incorrect lifestyles. The correlation between smoking and the pathology is now evident Regions) have acknowledged the need to take charge of the issue of lung cancer screening. Currently, we are witnessing a gradual implementation of low-dose CT screening in the area, awaiting the inclusion of lung screening in the LEAs”.
Even if “organized procedures have not yet been started – specifies the president Sirm – a first important step has been taken with the Peoplhe, Ccm, Italung 2 programs and with the creation of an early diagnosis path in the 18 centers of the Italian lung screening network (Risp), dedicated to smokers and former heavy smokers between the ages of 55 and 75. Coordinated by the National Cancer Institute of Milan, this program aims to evaluate the ability to identify cancerous and precancerous lesions thanks to the use of spiral CT. at minimal doses of radiation (even 1/20 of a standard CT scan), today the most powerful diagnostic radiological method available. The results of this study will be useful, at an institutional and governance level, in evaluating the validity of lung screening and subsequent adoption of a national secondary cancer prevention program for the population at risk, as already happens for the breast, cervix and colon. Furthermore, for heavy smokers there will also be a cardiovascular and pulmonary assessment in the presence of vascular calcifications or signs of emphysema. , bronchial inflammation or interstitial alterations. In light of the great advantages of early diagnosis on this pathology, we hope it can become a reality as soon as possible.”
Prostate cancer, “with more than 41 thousand new diagnoses in 2023, is confirmed as the most frequent neoplasm in the male gender. It represents almost 20% of tumors affecting men – underlines Gianpaolo Carrafiello, president of the 51st Sirm National Congress – The incidence increases with age, with a peak from 50 years onwards. The stage of the disease at the time of diagnosis has a strong impact on therapeutic opportunities and survival implement screening on the population at risk for this pathology”.
“The European Community – recalls the specialist – has recommended that all countries adopt diagnostic investigations, initially in the context of scientific studies, as happens today for the lung, in order to subsequently be able to offer real screening programmes. Today the analysis of Psa (prostate specific antigen) is the most used test to identify this neoplasm, but it is not offered by the national health system as an organized path – observes Carrafiello – they offer us the possibility of diagnosing the pathology in advance: if should the Psa values require it, we can first carry out a multiparametric magnetic resonance imaging, and then make use of fusion, a technique of fusion of images coming from different diagnostic methods, such as magnetic resonance imaging and ultrasound, allowing the biopsy of even small lesions only visible in MRI under ultrasound guidance, a quicker, easier and cheaper method”.
As for breast cancer, it is “the most frequent in women”, given that “it represents as much as 30% of all female tumors – explains Nicoletta Gandolfo, president-elect of Sirm – Mammographic screening has reduced mortality by 40%, proving the first unequivocally useful tool against the disease. Unfortunately, participation in the program varies from region to region, because the offer is not homogeneous in terms of age groups. In some regions the extension is from 45 to 74 years , while, in the majority, the exam is aimed at asymptomatic women between 50 and 69 years old. A second difference is consequent to the structural and organizational implementation of the program in each individual region. It is fundamental – reiterates the president-elect Sirm -. promote correct information, through awareness campaigns with the support of voluntary associations, so that the population is aware of the importance of this preventive public health intervention, especially in the South, where participation percentages are just over 20%. In case of positivity or diagnostic doubt in the screening, further in-depth tests will be carried out to allow a definitive diagnosis.”
In diagnostic imaging in breast medicine, “in addition to tomosynthesis – concludes Gandolfo – we now also have mammography with contrast medium available, which is used in doubtful cases or positive cases at screening, and which can replace breast magnetic resonance imaging when it appears indicated but it is not possible to carry it out (claustrophobia, allergy to Gadolinium, etc. Finally, strong recommendations come from the European Union for the implementation of lung cancer screening programs using low-dose CT, with an estimated reduction in risk). mortality of 26% for 10 years”.
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