PolmoniAMO_INGL

24 Lung cancer, more so than any other lung disease, requires a multidisciplinary approach involving oncologists, thoracic surgeons, radiotherapists, radiologists, respiratory physio- therapists, pulmonologists, pathologists, molecular biologists and GPs. The latter could be an excellent advocate for screening. However, for the medical community as a whole and, most importantly, GPs to be able to act as advocates of screening, they must be convinced of the favourable cost-benefit ratio of screening. For this to happen, it is important to pro- mote information about the screening results, i.e. an increasing percentage of individuals cured or ‘saved’ by screening who can act as spokespersons for those at risk, attesting to the fact that screening can save lives. With this in mind, GPs acting as spokespersons for stop-smoking initiatives and reporting an increasing number of patients who, thanks to screening, have been able to get treatment in a timely manner can implement both primary prevention and early screening promotion interventions. As suggested by PASSI data on the monitoring of mammography screening, the effectiveness of screening promotion in- creases if the invitation from the ASL (local health authority) is accompanied by the recom- mendations of one’s own doctor or healthcare professional. An invitation letter alone is not enough to ensure that a woman attends her screening appointment: advice from a medical professional is crucial [58]. However, it is nevertheless important to take into account the marked inequalities in the uptake of screening programmes in the different regions of the country, as already witnessed by the different attitudes towards organ donation, includ- ing in relation to the different organisational capacities of each region to provide human and structural resources. Furthermore, a study conducted in the UK among smokers and former smokers revealed that the intention to undergo screening was higher when the in- vestigation was recommended by the patient’s GP when compared to invitations received from prevention departments [59]. The role of screening advocate can be strengthened by making GPs aware of the variety of information that can be gathered by LDCT for each patient and by facilitating earlier referral of silent or paucisymptomatic progressive dis- eases. Alongside the cultural work that needs to be done by specialists and GPs, it is imperative to start work on structural adjustments and the development of organisational protocols in order to make the full implementation of screening feasible at regional level. Incorporating lung screening into Italy’s national health policy measures would require: • a screening infrastructure, with reading and reporting systems, most notably a centralised system for readings, the classification of nodules, and the definition of timeframes; • criteria for the training of personnel dedicated to screening and to the patient’s diag- nostic and therapeutic pathway; • criteria for the identification of the population at highest risk and the creation of proto- cols to align diagnostic capacity with the population eligible for LDCT at the local level; • tools to integrate screening with primary prevention (stop-smoking) measures; • tools to link administrative databases and anatomic pathology data in order to identify lung cancer patients eligible for innovative therapies.