It is possible to examine people who have a high risk of lung cancer but do not yet have any symptoms. We call this screening for lung cancer. Screening often helps to detect lung cancer in an early stage. There are often more possibilities for treating lung cancer in an early stage. Without screening, lung cancer is normally discovered in a late stage. Very few people can be treated effectively at this point. The likelihood of dying from lung cancer is lower if the lung cancer is discovered at an early stage. Early detection of lung cancer can be defined as detection before symptoms are encountered.

Screening for lung cancer is carried out by performing a CT scan of the lungs. The CT scan regularly shows spots or abnormalities on the lungs. Certain spots are lung cancer.

Population screening for lung cancer will only be useful to people with a high risk of developing lung cancer. Lung cancer is mainly encountered in people who have smoked for a large part of their lives. The risk of suffering lung cancer continues to be high for a long period of time even after people have quit smoking.

For this study, we are looking for people who have smoked for a long time. For example, a pack a day for more than 20-30 years. Or 2 packs a day for 15 years. If people have stopped smoking, they should not have done so more than 10-15 years ago. As a result, it does not matter if you currently smoke or have already stopped. If you have never smoked cigarettes, you are clearly not exposed to a high risk and this study is not intended for you.

Are you being treated for lung cancer or have you been treated for lung cancer during the past 5 years?? Then the study will also not be useful for you.

The study team will use the questionnaire, which you can fill in and return, to evaluate whether you can participate. In addition, you must provide consent if you want to participate. Otherwise we cannot allow you to participate. The study team will carefully check all requirements. Everyone that meets the participation requirements will be allowed to take part.

Many factors determine the risk of you getting lung cancer. For instance, your age but also how much and for how long you have smoked. All these factors jointly determine the risk. The risk can be estimated by assessing the answers provided in the questionnaire. For this study, we are looking for people with a high risk of lung cancer.

If you are interested in taking part in the study, we ask you to fill in the questionnaire and the informed consent. You can become a participant if you have completed the informed consent and, due to the answers on the questionnaire, we expect you to have an elevated risk of lung cancer.

All participants will undergo a CT scan of the lungs. We will divide all participants into two groups prior to the first CT scan. These groups will be formed via a draw. Everyone thus has the same chance of joining each group. It is not possible to switch to the other group. This is the only way for us to compare the groups effectively. You will be sent a letter that tells you in which group you have been placed. 

At some locations, a small amount of blood will also be taken to see if your blood contains substances that could point to lung cancer. So we are asking for your consent to do this.

Here is an overview of the main advantages of screening:

• If lung cancer is detected and treated in an early stage (even before symptoms are encountered), it is possible to reduce the number of people that die from lung cancer. Of every 4 people that would die from lung cancer without screening, 1 could be saved by performing screening. 
• Your prospects will improve if the lung cancer is treated in an early stage .
• Lung cancer can be detected at an early stage, even before you encounter symptoms. The treatment of lung cancer in an early stage is less invasive than when treating lung cancer in a later stage.
• A CT scan takes 10 minutes and is not painful. You will not receive medication or an injection.
  You can eat and drink whatever you like before and after the examination. If you take medicines, you can continue as usual.

All participants will undergo a CT scan of the lungs. We will divide all participants into two groups prior to the first CT scan. These groups will be formed via a draw. Everyone thus has the same chance of joining each group. It is not possible to switch to the other group. This is the only way for us to compare the groups effectively. You will be sent a letter that tells you in which group you have been placed. 

At some locations, a small amount of blood will also be taken to see if your blood contains substances that could point to lung cancer. So we are asking for your consent to do this.

The study will focus on participants whose first CT scan showed no abnormalities that are suspected to be lung cancer. All participants will be drawn into two groups prior to the first scan. 

There are two groups:

• Study group 1: in the two following years, participants in this study group will receive a CT scan every year. Therefore, a total of 3 CT scans will be performed on their lungs. 
• Study group 2: participants in this study group will receive one CT scan of their lungs after two years.  Therefore, a total of 2 CT scans will be performed on their lungs. 

If abnormalities are actually discovered on the CT scan, you will still receive a CT scan every year. You may also be referred to the lung specialist for further examination. You can find more information under the section “what are the possible results?”

The stages of lung cancer that are encountered in the two study groups will be compared against each other. If the stages are similar, we will be able to increase the period of time between the two CT scans in people where no abnormalities were encountered during the first CT scan.

The study is being carried out by various European experts in the field of lung cancer screening. The study is being overseen by the Erasmus MC. They already have experience with large-scale scientific studies into the early detection of lung cancer and cardiovascular diseases in the Netherlands.

All research groups that take part already have experience when it comes to performing studies into lung cancer screening. The ‘4-IN-THE-LUNG-RUN’ study will be carried out in various countries, namely the Netherlands, Germany, England, France, Italy and Spain.

The Netherlands:

• Erasmus MC university medical centre
• iDNA 

Germany

• Essen University Hospital
• Heidelberg Cancer Institute

France

• Goustave Roussy - Cancer institute

Spain

• Catalan Institute of Oncology (Barcelona)

Italy

• National Cancer Institute Milan

England

• Nottingham University
• University Hospital London

The study is being funded by the European Research Commission

The Minister of Public Health, Well-being and Sport asked the Health Council to investigate whether the study is safe and whether careful consideration has been given to every aspect. The Health Council was positive about the scientific quality of the study as well as the harm-benefits ratio for participants. The Minister of Public Health, Well-being and Sport then issued a licence on 24 June 2021 to perform the 4-IN-THE-LUNG-RUN study.

It is up to you to determine what is too difficult for you. The screening will take approximately 10 minutes. But you must also consider your travel time. The screening can take place on various days (Monday to Saturday) and at various moments during the day (morning; afternoon; evening). You can always re-schedule the screening appointment if it does not suit you.

Lung cancer can exist for a long time without showing symptoms. People only experience symptoms, and visit their GP, once the lung cancer is in a late stage. This study actually aims to examine people who do not have symptoms.

Here you can find more information about what lung cancer screening entails. Please feel free to contact us if you have other questions. We will be pleased to assist you. You do not have to do anything else if you decide not to take part. We will not approach you again.

A CT scan takes 10 minutes and is not painful. You will not be administered medicines or an injection. You can eat and drink whatever you like before and after the examination.  Not everyone wants to undergo a CT scan. In this case, the choice is entirely yours. You are always free to choose whether you want to participate.

Screening can cause fear and uncertainty. There is a chance of lung cancer being discovered. This can be very tense for people. Of every 100 people that we examine, approximately 4 will have lung cancer and will thus receive bad news. You can personally decide whether you want this. We know that fewer people will die from lung cancer if lung cancer is detected and treated in an early stage, even before symptoms are encountered. If you would like to discuss your concerns and doubts with a member of staff, this is possible via xxx

You are completely free to decide whether or not you want to participate in the population screening study. Do you also know why you are not taking part? Perhaps one of the reasons has been mentioned in the list.

If you are already being treated by a physician, the process in question can be intensive. Provided that the treatment is not for lung cancer, there will be no objections for this study. You must personally decide whether you can and want to be part of this extra study. The choice is entirely yours.

For this study, we are looking for people with a potentially high risk of lung cancer. The study team will determine this using the questionnaire. One of the main factors in this case is whether you are or have been a long-term smoker. For example, you can fill in the questionnaire if you have smoked a pack of cigarettes a day for more than 25 years or at least 2 packs for 15 years (and did not stop smoking before 2005). The study team will then examine the whole questionnaire to determine whether you are eligible. Unfortunately, if you have smoked for a shorter period, less intensively or quit smoking before 2005, you will not be able to participate in this study. However, it is important for you to always consult your GP if you suffer symptoms that are associated with lung cancer. Your GP can offer you further assistance. 

Here is an overview of the main disadvantages of screening:

• Undergoing the CT scan, waiting for the result (approximately 3 weeks) and perhaps being called for an extra CT scan could make you feel fearful and concerned. If it later transpires that lung cancer has not been detected, all that uncertainty will have been for nothing.
• Lung cancer may be discovered that is in such a late stage that treatment is no longer possible. This means you will know that you are seriously ill for the rest of your life.
• Lung cancer may be detected that would otherwise never have been found without performing the CT scan. For instance, if you were to die from something other than lung cancer, before you experienced symptoms. In this case, you will know that you have lung cancer all that time.
• Screening does not offer certainty. Even if nothing is found on the CT scan, you can still get lung cancer later in life. 
• Screening for lung cancer is carried out using a CT scan. A CT scan is an examination that is based on X-rays. Radiation is also encountered in everyday life. However, because radiation can cause cancer, we try to minimise its use. These days, the amount of radiation needed is so low that there is very little risk of cancer.

It will not cost you anything to take part in the study. We will pay for the CT scans for which we invite you. You will be referred to a lung specialist if the CT scan shows an abnormality in the lungs. The lung specialist will then conduct further examinations and treat you if necessary. The study will stop, and regular healthcare will start, from the moment that you are referred to the lung specialist. From this moment on, care-related costs will be covered by your health insurance.

All men and women between the age of 60 and 79 years who live near the screening centres will be invited to complete a questionnaire. On 27 January 2022, the Ministry of the Interior provided consent to supply personal details so that a one-off approach could be made to the selected people. We will destroy your details if you do not become a participant in this study.