Israel to Launch First-of-its-kind Pilot for Early Detection of Lung Cancer

Despite exclusion from so-called health basket and insufficient infrastructure, green light given to publicly funded scheme

A CT lung scan being performed in the George Pompidou European Hospital's radiology department, in Paris, in 2015.
Raguet H. / BSIP

The Israeli Health Ministry announced on Sunday the launch of a pilot program aimed at early detection of lung cancer. Heavy smokers will be sent for low-intensity CT screening aimed at detecting signs of this particularly deadly form of cancer, according to the ministerial panel that decides what drugs and procedures are included in the so-called health basket.

Large-scale studies in the United States and Europe have shown that CT scanning in such cases can improve the chances of survival of the patient. Indeed, some research shows that early-detection procedures can reduce mortality among lung-cancer sufferers by about 40 percent among women and 26 percent among men.

This year the health-basket committee rejected for the fourth time the inclusion of such tests as part of those it agreed to underwrite, among other things because physicians' unions said the necessary infrastructure was lacking in the country. Although that decision was appealed to no avail by the Israeli Lung Cancer Foundation, the committee ultimately decided to pursue the pilot. However, it remains to be seen how many people will be tested, which hospitals will be involved and so on.

The experimental scheme is based on a plan prepared by Prof. Sigal Sadetsky, a senior epidemiologist and head of public health services at the Health Ministry, and is due last for two or three years. It is expected to include current and former cigarette smokers aged 55 to 75 – those who smoked more than a pack a day for 30 years, or more than two packs a day over a period of 15 years.

Prof. Sigal Sadetski, a senior epidemiologist and head of public health services at the Health Ministry, who prepared the plan for the new lung-cancer screening scheme, Feb. 24, 2019
Daniel Tchetchik

The launch of the new venture will necessitate training of radiologists and oncologists, adaptation of scanning equipment, creation of a program to monitor participants and a public information campaign.

A key concern is that the lack of suitable infrastructure and experience could lead to false positives, resulting in superfluous biopsies of lung tissue that may cause more harm than good.

So far no country has chosen to hold such a pilot within the framework of a publicly funded, nationwide scheme. The closest thing to it is a program initiated by Medicare in the United States.

Prof. Yochai Adir, head of the Israeli Association of Pulmonary Diseases, says they support the pilot. “We deem it efficient and necessary but it requires initial testing and the preparation of a suitable infrastructure so that it can be conducted under optimal conditions,” he said, adding that based on the American experience, people will need to be encouraged to be tested.

Prof. Dorith Shaham, head of the CT and thoracic-imaging department at the Hadassah Medical Center in Jerusalem, said that early detection significantly reduces mortality rates in cases of lung cancer, and that several countries already use low-radiation CT screening to that end. Preventive measures, including helping people to stop smoking, should also continue to be pursued to reduce the chance of death, Shaham added.

The Israeli Lung Cancer Foundation was founded in 2014 by Nir Peled, head of oncology at Soroka Medical Center in Be’er Sheva, and by Dr. Shani Shilo, a dentist and biochemist whose husband contracted lung cancer. Among other things the organization is still working to have the early-detection testing including in the health basket.