The international meeting in Madrid of the newly formed Alliance for Global Implementation of Lung and Cardiac Early Disease Detection and Treatment (AGILE) was held in May 2024. This diverse forum included health-care professionals, public health leaders, industry representatives, and patient advocates from many nations to discuss the status and implementation challenges of low-dose computed tomography (CT) screening for lung cancer, including the opportunity to impact global health beyond reducing lung cancer mortality alone.

Lung cancer screening has been implemented in several countries, with varying degrees of success, and is being piloted in many others, moving toward full-scale implementation. There is a growing recognition that success with lung cancer screening implementation depends on efforts to recruit all eligible, at-risk individuals.

There is also consensus that screening management services should be coordinated with primary care and relevant specialty services to efficiently detect and then manage the significant chest CT findings according to relevant clinical best practices. Routine attention to other preventive services, most importantly smoking cessation, is essential. Participants also concurred that collective sharing of experiences and best practices is also essential. Screening programs have shown that high cure rates might be achieved. Yet strategies to pursue early detection and achieve these high cure rates face even greater challenges in those countries with limited resources. Meeting participants heard moving testimony from African clinical leaders reinforcing the reality that achieving the full benefits of chest CT imaging is a profound global challenge.

Clinical Studies on Tobacco-Related Diseases

Lung cancer screening frequently leads to the detection of major tobacco-related comorbidities, including asymptomatic coronary artery disease, emphysema, and other findings. To assess the complementary benefit of actively managing these additional findings, many groups (including I-ELCAP [International Early Lung Cancer Action Program] and NELSON [Dutch-Belgian Lung Cancer Screening]) have been conducting studies to evaluate how best to extend the focus beyond lung cancer screening to include these additional tobacco-related diseases.

Of particular relevance, the initial results from the 4-In-The-Lung-Run trial continue to support the feasibility of simultaneous lung cancer, coronary calcium, and emphysema detection. The large, randomized Risk or Benefit in Screening for Cardiovascular Disease (ROBINSCA) trial is comparing the use of low-dose chest CT imaging–based coronary calcium status with standard Framingham study–based risk status in guiding cardiovascular management over 7 years to determine cardiac outcomes as well as all-cause mortality benefit.

AI Tools for Cancer Screening

The meeting participants also came to consensus about the potential beneficial use of artificial intelligence (AI) tools to address efficient screening workflows. In this setting, AI might allow more consistently effective, personalized approaches to tobacco cessation; as well as improve the detection, quantification, and integrated result reporting to support better clinical screening management. Although the potential of these AI tools is exciting, the discussion highlighted critical challenges.

How do we engage other thought leaders to collaborate in the evaluation of evidence and formulate implementation strategies? How do we achieve societal support to access the vast amount of imaging and meta data required for equitably functioning AI tool development and validation to ensure emerging AI tools are scalable to all global cohorts without bias?

The attendees supported the potential for these new imaging and computational innovations. However, given the burden of premature mortality related to prolonged tobacco exposure, there was much discussion on how to capture the full potential health benefit resulting responsibly and efficiently from chest CT screening routinely detecting early, presymptomatic lung cancer, cardiovascular disease, emphysema, and other diseases. Related questions such as how to more consistently improve uptake and sustain compliance with smoking cessation measures were considered, as success in this regard may enhance the cost-efficiency of lung cancer screening management and provide other substantial health benefits. Further, there was also consensus that emerging screening processes must be adapted to be responsive to the demographics and medical priorities of different national settings.

Public Health Potential

The conference concluded with a discussion of a multidisease-detection approach to tobacco-related conditions applied to what we know today, as lung cancer screening has broader public health potential for preventing premature deaths. However, there are challenges in thoughtfully implementing new imaging information in the appropriate clinical context consistent with best clinical practice across the relevant diseases in different countries. Attendees agreed that further urgent cross-disciplinary conversations are essential to responsibly realize greater health benefit from early detection, disease management, and prevention tools. Given the outsized global burden of premature tobacco-related disease, it is urgent that these opportunities move to active consideration for a roadmap to responsible implementation.