PolmoniAMO_INGL

22 The desired cultural shift will consist of three main axes: 1. increased awareness of the clinical relevance of data from the NLST, NELSON and MILD studies; 2. greater clarity on concerns about false positive and overdiagnosis rates asso- ciated with LDCT; 3. increased knowledge of the benefits, cost-effectiveness and potential of LDCT beyond cancer prevention. The first studies on lung cancer screening, conducted between the 1970s and the 2000s, used chest X-rays as a method of investigation which offered an easy, fast, widely available and inexpensive means of examination. However, this strategy failed because screen- ing did not provide any advantage in terms of reduced mortality. For a long time, these disappointing results left doctors convinced that it was not possible to screen for lung cancer [1]. Coupled with this scepticism was the perception that the operating methods of screening were inefficient, as the early experimental screening programmes involved the evaluation of individual X-ray films, thus making this process inefficient in practice and reinforcing doctors’ scepticism on this matter. The results of the NLST, NELSON and MILD studies have consolidated the scientific evidence supporting the use of LDCT. LDCT has been shown to fully meet the criteria defined by the WHO for screening [50], i.e. reliability, safety, acceptability, sustainability and ability to change the course of the disease. Furthermore, a cost-effectiveness analysis conducted in our country suggests that LDCT is associated with an incremental cost of €2,944 per life year gained in a high-risk population, suggesting that screening can be implemented at a low cost [43]. LDCT of the chest could be performed more or less often depending on the individual risk of each patient. This personalised strategy would optimise the use of instrumental and human resources and significantly reduce costs. It is worth remembering that the recent AIOM [Italian Association of Medical Oncology] guide- lines for lung cancer recommend annual screening as a first-choice option by means of a CT scan in smokers or former smokers who have smoked at least 15 cigarettes per day for more than 25 years, or at least 10 cigarettes per day for more than 30 years, or who stopped smoking fewer than 10 years ago [strong recommendation in favour] [51]. Giv- en the strength of these recommendations, the need to justify not ‘why’ to proceed with screening but rather ‘why not’ is becoming increasingly apparent. Finally, it should be noted that perceived scepticism and/or concerns about LDTC are often based on poor or no knowledge of this method, as suggested by a recent study conducted in the USA [52]. The number of false positives and overdiagnoses can be reduced by more accurately profiling and selecting the population at risk. Recent studies have evaluated the develop- ment of risk models, e.g. Lung-RADS or PLCOM2012, to select subjects eligible for LDCT based on the observation that increasing individual risk from the lowest to the highest