PolmoniAMO_INGL

16 essary surgical interventions. Finally, the analyses conducted on blood samples and res- piration were aimed at achieving an individual biological characterisation to enable the early recognition of pre-tumour patterns as well as the early identification of individuals genetically predisposed to lung cancer. The MILD study showed that an early detection programme that continues beyond 5 years to 10 years of screening can result in a 39% reduction in lung cancer mortality and a 20% reduction in overall mortality [40]. In order to reduce the number of unnecessary surgeries, the study protocol foresaw the active monitoring of ‘not entirely solid’ lesions, which proved to be an effective strategy for the management/monitoring of the slow-growing nodules that account for the majority of over-treated lung adenocarcinomas. Moreover, the selective use of PET scans improved the differential diagnosis, resulting in a resection rate for benign histology of 4.5%, far lower than the rates reported in the NLST (24.4%) and UKLS (10.3%) studies and the 15% threshold recommended by the National Comprehensive Cancer Network (NCCN) [2]. A recent meta-analysis examined the randomised trials conducted so far to estimate the benefits and risks associated with the use of LDCT in subjects with a smoking history in or- der to support the systematic implementation of lung cancer screening globally [37]. The analysis of nine studies involving a total of almost 90,000 patients revealed that the use of LDCT was associated with a significant reduction in lung cancer-related mortality in the order of 20%, an increase in diagnoses of early-stage (I-II) malignancies and a reduction in diagnoses of advanced malignancies, with no significant difference between women and men [37]. Although there is still a degree of uncertainty about the extent of overdiagnosis, the benefits of LDTC outweigh the risks in individuals with a smoking history, thus sup- porting (in accordance with the results of the NLST, NELSON and MILD studies) the launch in Italy of early diagnosis programmes through the use of LDCT in heavy smokers over the age of 55, to be developed in centres highly specialised in the areas of early diagnosis and the treatment of lung cancer. LDCT therefore appears to be a promising life-saving strategy [24] suggesting that lung cancer screening is an effective public health intervention in terms of number of lives saved, after cervical, colorectal and breast cancer screening. If we consider that approximately 60% of deaths caused by lung cancer in Italy occurred in heavy smokers (20,400 of the total 34,000), a 20-25% reduction in mortality would trans- late into more than 5,000 fewer deaths each year in the country. In Italy, according to international guidelines the population eligible for lung screening with LDCT is estimated to be between 600,000 and 800,000 individuals [41]. When offered to the population at highest risk of developing lung cancer, based on age and tobacco exposure [e.g. over 55 and with a history of heavy smoking (≥30 packs/year)], LDTC is a highly effective health resource. In fact, fewer people need to undergo LDCT (320) to prevent a death from lung cancer than need to undergo a mammography (646- 1724) or sigmoidoscopy (864) to prevent a death from breast or colorectal cancer respectively [42]. Furthermore, prospective studies conducted in Italy show that it is