▶️THEME INTRO | SCREENING & PREVENTION – MSD
How does the business model around prevention work for a pharmaceutical company (counterintuitive)?
As an innovative pharmaceutical company, we are part of the Belgian healthcare ecosystem and we strive for better cancer care at all stages of the patient journey, including prevention, diagnostic, treatment, and survivorship. In Belgium, there are already screening campaigns for breast cancer, colon cancer and cervical cancer, but no screening for lung cancer whilst it is one of the deadliest cancers. There is an urgent need to change that situation. Belgian citizens should be offered the possibility to detect lung cancer earlier. However, screening all Belgian population would be costly and inefficient. Therefore, we need to find a way of targeting the screening campaigns towards the citizens who are the most at risk: mainly (former) smokers from a specific age category and with a specific smoking history (expressed in terms of packyears). If lung cancer is detected earlier, patients could be treated in better conditions and survival rate would increase. It is what drives us in proposing this challenge.
Why does prevention move, and why now?
The ageing of the population is leading to more chronic diseases and greater demand for care. Shifting spending to prevention allows clear savings as preventive actions are less expensive than treatment or other acute interventions in health. Investing in screening programs that identify diseases at an early stage allow for implementation of treatment at the most beneficial time. And it allows for health gains and long-term economic benefits.
What underlying problems does it solve, and what is the scale of the problem?
In 2020, 8.874 Belgian citizens were diagnosed with lung cancer, and the average 5-year survival rate amounted to 22,8% for man and 31,4% for woman. As we know that lung cancer survival rate is largely linked to the stage of diagnosis and that lung cancer, nowadays is, for 57% of the cases diagnosed in stage 4, when the cancer has already spread out of the lungs in other parts of the body, we need to collectively move the needle towards screening and earlier diagnosis to increase the proportion of citizens who might be diagnosed in stage 1, where 5-year survival rate amounts to 77%-92%, compared to 10% for stage 4 cancers.
What exactly are you bringing to the attention of the healthcare ecosystem at Hack Healthcare? (Challenge on Lung Cancer Screening)
Lung cancer is amongst the deadliest cancer. Its symptoms appear only at a late stage, and accelerating population-level screening in Belgium is currently not yet established in Belgium. As cigarette smoking is linked to about 85% to 90% of lung cancer deaths, smoking history could be used to identify candidates for screening. Unfortunately, smoking history data is scattered across the healthcare ecosystem, and can’t be effectively used.
How might we identify existing sources of smoking history data for the estimated 15% of Belgians who are smokers or former smokers, aggregate (in full respect of patients’ rights) and enrich this data, evaluate the need for additional touchpoints for collecting it, and make it actionable for screening purposes by health authorities, as well as to motivate smokers and former smokers to undergo screening?
If the promise of the impact of prevention is so relevant, why hasn’t it happened yet? What are the challenges that you see in making these bottlenecks go away and with whom would you work to solve them?
One key aspect of prevention is the efficiency of the prevention measures: if tomorrow we invite all the Belgian population for screening of lung cancer, it will not be cost-efficient because only a very small part of the population will have a lung cancer diagnosed. For each type of disease, you would like to prevent, you need to identify the population at higher risk of developing the disease. And sometimes, even if you know who is at higher risk – in this case smokers and former smokers from a specific age group and with a specific smoking history – you need to find a way to contact that higher risk population and motivate them to participate in screening programs. Targeting the right population group is the key for a screening program to be cost-effective. That is the challenge we want to address with Hack Healthcare.
Who are you the most excited to see working on your challenge during the event?
It is very energizing to see that many stakeholders have answered positively to our invitation to work on that specific challenge: patients, lawyers specialized in GDPR, occupational physicians, GPs association, tech. companies, … We are very pleased that such a diverse group of people with their very specific background and expertise will work together to support the development of lung cancer screening in our country.
 Source : https://kankerregister.org/default.aspx?Pageld=344 , extension://elhekieabhbkpmcefcoobjddigjcaadp/https://kankerregister.org/media/docs/CancerFactSheets/2020/Cancer_Fact_Sheet_LungCancer_2020.pdf (p.6). Accessed on 26 April 2023.
 Source : https://kankerregister.org/default.aspx?Pageld=344 , extension://elhekieabhbkpmcefcoobjddigjcaadp/https://kankerregister.org/media/docs/CancerFactSheets/2020/Cancer_Fact_Sheet_LungCancer_2020.pdf (p.7). Accessed on 26 April 2023.
 Source: 1. Worley S. Lung cancer research is taking on new challenges: knowledge of tumors’ molecular diversity is opening new pathways to treatment. P T. 2014 Oct;39(10):698-714. PMID: 25336866; PMCID: PMC4189696. Accessed on 26 April 2023.
- Goldstraw P. et al. J. Thorac.Oncol. 2016; 11(1):39-51. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer – Journal of Thoracic Oncology (jto.org). Accessed on 26 April 2023.
 https://www.kanker.be/sites/default/files/publication/longkanker-09-04-2020.pdf p.6 . Accessed on 26 April 2023.
 Health Interview Survey, Sciensano, 1997-2018. https://www.sciensano.be/fr/projets/enquete-de-sante. Accessed on 26 April 2023.