It’s an ongoing work we are presenting and it will be an effort over many years to really implement it – early detection throughout the world. The problem is that screening is doable with the methods we have now and the indications and risk factors we are using now in high income countries; it’s probably not doable in the same way in low and middle income countries. On the other side, the numbers of lung cancers overall are much higher in the low and middle income countries than in the countries where screening is doable with the concepts we have now. 

Therefore we have to evaluate for each region what are the most important risk factors, what are the competing health problems, for example infections, tuberculosis, HIV, and perhaps we can then integrate lung cancer screening in this situation, so in these programmes. We have even to think of whether we will go back partly to chest x-rays and use artificial intelligence, computer aided diagnosis, to get the nodules out of the images which are done, for example, for tuberculosis search and then follow-up regarding the lung cancers.

We know that in other regions smoking is not the only relevant risk factor so air pollution, for example, indoor cooking, genetic factors. So it’s a variety of risk factors we have to look at and we will see how to handle it. So it’s definitely a work in progress. We are now collecting the data throughout the world and looking at how we could then suggest a good solution for the various regions. 

A further point is that we know now that, apart from that direct primary screening, also the strict follow-up and management of incidental nodules which are found on chest x-rays or CT which were done for other reasons, if these people are then followed up and diagnosed then they have also an earlier stage of lung cancer and also a better prognosis.