Knowledge and experience exchange with Sweden: Early detection of lung cancer in never-smokers

Lung cancer accounts for one in five deaths worldwide. The past few years have seen considerable advances in treatment for lung cancer, yet the prognosis remains low. Lung cancer causes symptoms that come up late in the course of the disease and assessments are complicated. This means that half of the patients have a spread disease at diagnosis.

Early detection and prevention are the best strategies to improve the treatment outcome or eliminate the disease. People who smoke or have smoked have the greatest risk of lung cancer, though lung cancer also increasingly occurs in people who have never smoked. Lung cancer in never-smokers is a global rising concern and there is a fast growing need to understand how never-smokers’ disease differs from that of smokers, and how to effectively prevent and diagnose it early.

Vision Zero Cancer therefore invited participants ranging from current leading researchers in the field and clinicians to patient representatives and the medical industry to share experience and discoveries on how to develop an effective preventive strategy and opportunities for screening.

The meeting held around 30 participants and keynote speaker was Dr. Pan-Chyr Yang (MD, PhD, Chair Professor at the National Taiwan University Hospital and Academician of Academia Sinica, Taiwan). Dr. Yang shared the findings of the Taiwan Lung Cancer Screening for Never-Smoker Trial (TALENT), a nationwide lung cancer low-dose CT screening study focused on never-smokers which also aims to develop an effective strategy for screening of lung cancer in never-smokers and establish a risk prediction model to identify high-risk population that may benefit from low-dose CT screening.  In Taiwan, lung cancer is the leading cause of cancer mortality, and 53% of those who have died of lung cancer were never-smokers. The US National Lung Cancer Screening Trial (NLCST) and the Dutch NELSON trials demonstrated that the use of low-dose CT is effective for lung cancer screening; however, most of the lung cancer screenings focused on heavy smokers.

Of the 12,011 individuals included in the trial, the prevalence of lung cancer was 3.2% and 2.0% in participants with and without lung cancer family history, respectively. As explained during the meeting by Dr. Yang, 96.5% of the detected patients were stage 0 or 1 and potentially curable by surgery. The study also demonstrated the high risk of family history, especially among participants with a first-degree family history of lung cancer.The meeting further contained a panel discussion where Andrew Kaufman (MD, Associate Professor, thoracic surgeon at Mount Sinai Hospital in New York City) Kersti Oselin (MD, PhD, Medical Oncologist, North-Estonian Regional Hospital Cancer Center) Marcela Ewing (MD, PhD, Specialist Oncology and General Medicine, Sahlgrenska Academy, Regional Lead Early Detection of Cancer, Confederation of Regional Cancer Centres) Mattias Johansson (PhD, Scientist, Genetic Epidemiology Group, International Agency for Research on Cancer (IARC), World Health Organization) and Mikael Johansson (MD, Associate Professor, Senior Consultant Oncology, Umeå University Hospital and Senior lecturer at Umeå University, Chair of the National Working Group for Lung Cancer Care) together with Dr. Pan-Chyr Yang elaborated their thoughts on the findings of the TALENT-study and how this relates to what they are facing in their current work.

Andrew Kaufman who is the leader of the never-smoking initiative at Mount Sinai Hospital, New York, reflected that caring for never-smoking lung cancer patients comes down to the intersection between epidemiology, biology, clinical capability, precision medicine, surgical care and all other clinical attributes available. He put emphasis on that it takes a multidisciplinary approach to look at the data and find out what is the substrate we are dealing with in terms of a clinical population, while also stating that for most cancers unfortunately the time for best intervention is at an asymptomatic time point. Dr. Kaufman continued by being hopeful that discussions like the one this meeting facilitated will shed light on and give direction to find the right thread to start pulling on to make a difference in the case of lung cancer. By learning from the important findings of Dr. Yangs work we will be able to provide ways to be smarter at identifying patients at risk yet also not increasing the costs of the inefficiency of care.

The various competent outlooks and insights presented by the panel gave a good transition to the last part of the meeting where Mattias Johansson from the Genetic Epidemiology Group at the WHO International Agency for Research on Cancer (IARC) presented a proof on concept study on the use of biomarkers to improve early detection and the possibilities this presents to detect more lung cancer patients in time. Medical oncologist Kersti Oselin from the North-Estonian Regional Hospital Cancer Center gave insights on AI for early detection and the prognostic significance of genomic markers in lung cancer recurrence. Rounding up the meeting from London Amied Shamaan, director within AI and clinical collaboration presented the work of a collaboration between Oxford University and GE Healthcare with other industry partners in a consortium that is formed around lung cancer screening and innovation and goes under the name of  The Integration and Analysis of Data using Artificial Intelligence to Improve Patient Outcomes with Thoracic Diseases (DART). The consortium has come together to be agile around the lung cancer screening process in the UK to provide innovation in technology and to be able to involve and better affect the patient population.

During the autumn follow-up meetings will be held to dig deeper into the common areas and challenges facing early detection of never smokers. Leveraging clearly on the consensus of the meeting around the need to gather across professions and sectors to build momentum around who and how to find never-smoking lung cancer patients at the right time. 

Watch the recording of the meeting.

Meeting agenda Följ länk

The purpose of this meeting was to share discoveries and experience on how to develop an effective preventive strategy.

Hur ser vi cancern snabbare?

Ju tidigare cancer upptäcks, desto större är chanserna att överleva. Med nya system och kunskaper kan vi fånga upp symptom tidigare och snabbare komma till behandling. Och får större chanser att nå nollvisionen.

Tidig upptäckt och diagnos
Följ länk

Estonia-Sweden workshop on cancer – improving health outcomes through innovation and collaboration

The aim of Europe’s Beating Cancer Plan is to tackle the entire disease pathway. Over the coming years, it will focus on research and innovation, tap into the potential that digitalisation and new technologies offer, and mobilise financial instruments to support Member States. With its policy objectives, supported by ten flagship initiatives and multiple supporting actions, the Cancer Plan will help Member States turn the tide against cancer. Sweden and Estonia have decided to join forces in this endeavour.

On the 26th of May North Estonia Medical Centre Regionaal Haigla and Vision Zero Cancer arranged an interactive meeting to share experience and explore areas for collaboration in research and innovation to deliver on the mission of beating cancer. The meeting was focused around five key areas presented after the shared introduction by Dr. Terje Peetso (MD, Member of the Board at North Estonia Medical Centre) and Ebba Hallersjö Hult (Head of Vision Zero Cancer).

Bettina Ryll (MD, PhD, member of the Horizon Europe Mission Board for Cancer, Chair ESMO Patient Advocacy Group, Founder Melanoma Patient Network Europe) shared her thoughts on the emergence of A new era in cancer care in Europe followed by Professor Hans Hägglund (MD, Professor, National Cancer Coordinator, Chairman of the Federation of Regional Cancer centres, Chairman of Vision Zero Cancer) who painted the picture of the Swedish setting of 10 years with a national strategy – achievements and future outlook complemented by Dr. Vahur Valvere (MD, PhD, Director of Research and Development, North-Estonian Regional Hospital Cancer Center, Chairman of the Board of Estonian Cancer Society) giving the outlook of the Estonian National Cancer Control Plan for 2021-2030.

Mia Rajalin (PhD., lic. psychologist, Director of Studies, Region Stockholm, Member of the Board, the Swedish Lung Cancer Association and Vision Zero Cancer) member of the Vision Zero Cancer core-team and lung cancer patient gave her story of how the diagnosis became a driver for improving cancer care. The case of lung cancer was further elaborated by Dr. Simon Ekman (MD, PhD, Associate Professor, Senior Consultant, Department of Oncology-pathology, Karolinska University Hospital and Karolinska Institutet) and Dr. Kersti Oselin (MD, PhD, Medical Oncologist, North-Estonian Regional Hospital Cancer Center) sharing experiences from the Swedish Precision treatment of lung cancer at Karolinska Comprehensive Cancer Center and Estonian work with AI for early detection and prognostic significance of genomic markers in lung cancer recurrence.

Anu Planken (MD, PhD, Medical Oncologist, North-Estonian Regional Hospital Cancer Center) presented an Overview of the personalised oncology landscape in Estonia building on the promise of personalized medicine for cancer prevention, diagnosis and treatment.  Complementing this with the perspective of data and information-sharing Arvid Widenlou Nordmark (Coordinator National Quality Registries for Cancer, Confederation of Regional Cancer Centres) gave the Swedish view of how national quality registries are used to guide and evaluate clinical improvement efforts and introduced the The Patient Overview – an enabler for personalised medicine. Rounding up the group of speakers was Dr. Indrek Seire (MD, Surgical Oncologist, North-Estonian Regional Hospital Cancer Center) giving an oversight of the Estonian work with Structured health data and site-based databases in oncology. 

The meeting continued with the approximately 25 participants being split into breakout groups discussing the question of how we can leverage the promise of personalised medicine (PM) for our patients and societies? with the goal of both sharing knowledge and insights while strengthening possibilities for successful international collaborations.

The successful outcome of the meeting has led to a deepened collaboration within cancer care between Sweden and Estonia with planned visits and experience exchanges on site in Sweden during the autumn 2021 and in Estonia in the spring of 2022.  

Watch the recorded meeting.

Meeting agenda Följ länk

North Estonia Medical Centre Regionaal Haigla and the Swedish Innovation Milieu Vision Zero Cancer held an interactive meeting to share experiences and explore areas for collaboration in research and innovation to deliver on the mission of beating cancer.

Kunskap delas över gränser

Nollvision cancer anordnar och deltar i internationella möten för att utbyta kunskap och lära av varandras projekt, resultat och tankar.

Internationella aktiviteter
Följ länk

Det här är vi

Nollvision cancer ska omvandla cancer från en dödlig till en botbar eller kronisk sjukdom.

Om Nollvision cancer
Följ länk

Sweden-Russia experience exchange on lung cancer – accelerating innovation to improve survival and quality of life for people with lung cancer

Around 60 experts gathered during the virtual experience exchange between Sweden and Russia as part of a collaboration between the Association of Oncologists of Russia and Vision Zero cancer, aided by Business Sweden and the Embassy of Sweden to the Russian Federation.

A warm and shared welcome to the meeting was given by H.E. Malena Mård, Ambassador of Sweden to the Russian Federation, Mattias Lindgren, Swedish Trade Commissioner to the Russian Federation, Market Area Director Eurasia, Business Sweden, Professor Andrey Kaprin, MD, General Director of the National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, President of the Association of Oncologists of Russia, and Ebba Hallersjö Hult, Head of Vision Zero Cancer. The scene for Cancer care in Russia and Sweden with particular focus on lung cancer was set by presentations from Professor Andrey Ryabov, MD, Deputy General Director of the National Medical Research Radiological Center of the Ministry of Health of the Russian Federation and Associate Professor Mikael Johansson, MD, Senior Consultant Oncology, Umeå University Hospital and Senior lecturer at Umeå University.

The presentations and following discussions centred around three key areas containing an impressive 25 expert speakers giving their view on (1) Prevention, Improved awareness and Education, (2) Early Detection and Screening and(3) Diagnostics, Treatment and Care.

Attached to this short overview is the full agenda (link).

The meeting has further underbuilt the coming memorandum of cooperation (MoC) between the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation (NMRRC), the Association of Oncologists of Russia (AOR) and Vision Zero Cancer as well as paved way for experience exchanges on site in Sweden and Russia. All to continue the common fight against cancer.

Meeting agenda Följ länk

The purpose of this meeting was to share knowledge and experience on how to improve early cancer diagnosis, outcomes and care for patients and to discuss potential new technologies for early lung cancer detection, including the implementation of targeted screening and precision diagnostics and treatment.

Kunskap delas över gränser

Nollvision cancer anordnar och deltar i internationella möten för att utbyta kunskap och lära av varandras projekt, resultat och tankar.

Fler internationella aktiviteter
Följ länk

Det här är vi

Nollvision cancer ska omvandla cancer från en dödlig till en botbar eller kronisk sjukdom.

Om Nollvision cancer
Följ länk

Lösningar i fokus på Sweden-India Health Talks 2020

Hur stärker vi cancervården och gör den mer motståndskraftig, särskilt i ljuset av de utmaningar som covid-19 ställt oss inför? Det diskuterades i ett rundabordssamtal under Sweden–India Health Talks 2020 den 11 december. Nollvision cancers Ebba Hallersjö Hult deltog, tillsammans med Karin Elinder från Cancerfonden.

Försenad diagnostik, uppskjuten screening och uppskjuten behandling – pandemin ställer oss inför flera utmaningar. Det, och andra utmaningar för cancervården, diskuterade experter från offentlig och privat sektor i Indien och Sverige, i Sweden–India Health Talks som en del av Sweden–India Nobel memorial week.

Rundabordssamtalet fokuserade på att identifiera cancerrelaterade utmaningar och hur pandemin kräver mer än innovation i lösningarna. De mest kritiska hindren i vårdkejdan identifierades som screening och tidig upptäckt, socioekonomiska skillnader, brist på kunskap om cancer och cancerprevention bland befolkningen samt ojämlik tillgång till vård. För att hitta vägar förbi dessa hinder delade vi erfarenheter, best practice och nytänkande förslag. Samarbete är centralt för att hitta en hävstångseffekt i den teknologiska utvecklingen och för att arbeta tvärfunktionellt, såväl kring den enskilda patientens vård som i att utveckla preventionsarbete genom till exempel beteendevetenskap. Tillsammans jobbar vi för en bättre global cancervård!

Läs mer om India–Sweden Healthcare Innovation Centre.

Hur ser vi cancern snabbare?

Ju tidigare cancer upptäcks, desto större är chanserna att överleva. Med nya system och kunskaper kan vi fånga upp symptom tidigare och snabbare komma till behandling. Och får större chanser att nå nollvisionen.

Tidig upptäckt och diagnos
Följ länk

Har du idéer som kan förbättra cancervården?

Vi vill gärna att fler aktörer engagerar sig Nollvision cancer, genom samarbeten i specifika insatser och genom partnerskap. Tillsammans kan vi skapa ännu större nytta för patient och samhälle.

Engagera dig
Följ länk

Lungcancerscreening – vad är framgångsfaktorerna i Storbritannien?

Livmoderhalscancer, kolorektalcancer och bröstcancer är exempel på cancerformer som ofta upptäcks tidigt genom screening. Det räddar flera hundra liv varje år. Kan screening fungera för lungcancer? Storbritannien har testat. För att lära oss av deras projekt, resultat och tankar möttes vi i ett digitalt samtal.

Storbritannien har genomfört flera projekt och studier om lungcancerscreening. I slutet av september fick vi ta del av deras lärdomar från sjukvården, universitet och medicinteknikbolag, som en del i arbetet med att se om ett nationellt screeningprogram för lungcancer kan vara något för Sverige.

Dr. Philip Crosbie, Manchester University, delade med sig av ett projekt i Manchester, där de genom en enkätundersökning kommit till insikten att patienter tyckte att det var opraktiskt att besöka kliniken. Därför införde de en screeningbuss för att ta tjänsten direkt till patienten.

Professor David Baldwin, East Midlands Cancer Alliance, berättade hur de hittade och tog kontakt med svåråtkomliga patienter – en kombination av mobil screening och telefonkontakt. Han betonade styrande protokoll som en förutsättning för enhetlig och standardiserad vård. Baldwin lyfte också vikten av rådgivande kommittéer och att lära av varandra.

Ytterligare ett brittiskt projekt, där den statliga sjukvården, Oxford University och aktörer från life science industrin jobbar tillsammans, undersöker hur AI kan diagnostisera lungcancer mer exakt och snabbt. Och samtidigt minska mängden invasiva ingrepp. Algoritmer blir sjukvård. 

Professor Annie Mackie, Public Health England, beskrev hur Storbritannien ser på ett nationellt screeningprogram för lungcancer. Nu, när det kommit mer bevis från publicerade studier i Nederländerna och USA på att riktad screening är effektivt mot lungcancer, diskuterar de en policyförändring – men det finns fortfarande en hel del frågor som behöver svar. Hur väljer man vilka som ska screenas? Vilka etiska ställningstaganden måste göras? Hur ska screeningen byggas upp?

Den svenska forskaren Mattias Johansson delade med sig av forskargruppens arbete vid International Agency for Research on Cancer med att använda biomarkörer som modell för att hitta rätt patienter. Om screeningen till exempel bara innefattar rökare så missas en stor patientgrupp. Det framtida målet är att kunna förutse risker med hjälp av proteiner, som komplement till risker som upptäcks via frågeformulär.

Framgångsfaktorerna från Storbritannien kan sammanfattas med att vården ska vara tillgänglig på medborgarens och patientens behov, att samverkan mellan klinik, forskning och andra aktörer behövs, och att digitala verktyg kan göra vården effektivare. Lungcancerscreening fungerar, men måste genomföras på rätt sätt för att ge resultat, vara effektivt och rädda liv.

Mer om workshoppen

Agenda för kunskapsutbytet Följ länk

Erfarenheter från studier om lungcancerscreening i England, potentiell ny teknologi och tankar från Englands nationella screeningkommitté.

Vilka som deltog i kunskapsutbytet Följ länk

Experter från England och Sverige träffades i ett digitalt samtal.

Hur ser vi cancern snabbare?

Ju tidigare cancer upptäcks, desto större är chanserna att överleva. Med nya system och kunskaper kan vi fånga upp symptom tidigare och snabbare komma till behandling. Och får större chanser att nå nollvisionen.

Tidig upptäckt och diagnos
Följ länk