In Reply

Lung Cancer Screening Using Low Dose CT Scanning in Germany by Prof. Dr. med. Andreas Stang, MPH, Prof. Dr. med. Martin Schuler, Dr. rer. nat. Dr. rer. san. Bernd Kowall, Dr. med. Kaid Darwiche, PD Dr. med. Hilmar Kühl, and Prof. Dr. rer. nat. Karl-Heinz Jöckel in issue 38/2015

We fully agree with the statement by Brenner and colleagues that more “substantiated extrapolations and simulation studies…for health policy decisions and prioritizations” are required in Germany to avoid “blind flying in cancer prevention”. The aim of our article was to draw attention to, with the help of such an extrapolation, the public debate on the benefit assessment of low-dose computed tomography screening in Germany and to the numerous relevant factors involved (including number needed to screen [NNS], number needed to harm [NNH], overdiagnosis, cost effectiveness, and quality of life).

It is extremely important to consider not only extrapolations and simulations prior to introducing a screening procedure but also a systematic and efficient evaluation after it has been introduced. For instance, screenings for breast cancer and skin cancer were introduced in Germany before conditions were in place to allow them to be evaluated in a timely, systematic, and efficient manner (1, 2).

A recently published, detailed analysis of cause-of-death statistics in the German federal state of Schleswig-Holstein revealed that the evidence for a decrease in melanoma mortality in Schleswig-Holstein is substantially weaker than previously assumed (3). The expected reduction in mortality from malignant melanoma of the skin has still not been shown (2, 3).

Evidence-based and cost-benefit assessments before and after the introduction of screening procedures must have a sustainable place not only in clinical, but also in preventive medicine.

DOI: 10.3238/arztebl.2016.0297b

Prof. Dr. med. Andreas Stang, MPH
Zentrum für Klinische Epidemiologie;
Institut für Medizinische Informatik, Biometrie und Epidemiologie,
Universitätsklinikum Essen
School of Public Health, Department of Epidemiology, Boston University, USA
Deutsches Konsortium für Translationale Krebsforschung (DKTK), Essen

Dr. rer. nat. Dr. rer. san. Bernd Kowall
Zentrum für Klinische Epidemiologie; Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen

Prof. Dr. med. Martin Schuler
Deutsches Konsortium für Translationale Krebsforschung (DKTK), Essen
Westdeutsches Tumorzentrum, Innere Klinik (Tumorforschung),
Universitätsklinikum Essen
Abteilung Thorakale Onkologie, Ruhrlandklinik, Universitätsklinikum Essen

Dr. med. Kaid Darwiche
Abteilung für Interventionelle Pneumologie, Ruhrlandklinik,
Universitätsklinikum Essen

PD Dr. med. Hilmar Kühl
Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen

Prof. Dr. rer. nat. Karl-Heinz Jöckel
Institut für Medizinische Informatik, Biometrie und Epidemiologie
Universitätsklinikum Essen
Deutsches Konsortium für Translationale Krebsforschung (DKTK), Essen

Conflict of interest statement

Prof. Schuler has received consultant fees (advisory board) from AstraZeneca, Boehringer Ingelheim, Novartis, and Celgene, honoraria for expert opinion in legal proceedings, and conference fee reimbursement from Boehringer Ingelheim and Lilly. He has received financial support for research (third-party funds) from AstraZeneca, Boehringer Ingelheim, BMS, Lilly, and Novartis. He is a member of the scientific committee of the Institute for Quality and Efficiency in Health Care (IQWIG).

The remaining authors declare that no conflict of interests exists.

References

1. Fuhs A, Bartholomaus S, Heidinger O, Hense HW: [Evaluation of the impact of the mammography screening program on breast cancer mortality: feasibility study on linking several data sources in North Rhine-Westphalia]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 57: 60–7

2. Katalinic A, Eisemann N, Waldmann A: Skin cancer screening in Germany. Dtsch Arztebl Int 2015; 112: 629–34

3. Stang A, Jöckel KH: Does skin cancer screening save lives? A detailed analysis of mortality time trends in Schleswig-Holstein and Germany. Cancer 2015; doi:10.1002/cncr.29755 (Epub ahead of print)

4. Stang A, Schuler M, Kowall B, Darwiche K, Kühl H, Jöckel KH: Lung cancer screening using low dose CT scanning in Germany— extrapolation of results from the National Lung Screening Trial. Dtsch Arztebl Int 2015; 112: 367–44