Vorsorgeuntersuchungen und Check-ups in der Pneumologie

Abstract

In pneumology, preventive check-ups have played a subordinate role so far. Current research results could change this. In the following article the focus is on lung cancer and COPD, diseases that have a considerable influence on mortality and morbidity in modern society. Approaches will be discussed that will allow earlier diagnosis of COPD or identify patients at risk. In particular Capture, a questionnaire that significantly increases the pre-test probability in COPD diagnostics, should be mentioned here. Lung carcinoma screening is a controversial topic in Germany. In an American study, the relative mortality rate from lung cancer was significantly reduced by CT screening. Results of a European study (Nelson trial) are still pending. A high pre-test probability will also be decisive for lung cancer screening. In this way, the cost-benefit ratio could be optimized. Since COPD patients have a significantly increased risk of lung cancer, there might be overlaps in the screening procedures.

In der Pneumologie spielen Vorsorgeuntersuchungen bisher eine untergeordnete Rolle. Aktuelle Forschungsergebnisse könnten daran etwas ändern. Im Folgenden wird der aktuelle Stand der Vorsorgeuntersuchungen näher beleuchtet. Der Fokus liegt auf dem Lungenkarzinom sowie der chronisch obstruktiven Lungenerkrankung, die einen erheblichen Einfluss auf die Mortalität und Morbidität in unserer Gesellschaft haben.

Schlüsselwörter

Vorsorgeuntersuchungen - Lungenkarzinom - COPD - CAPTURE - NELSON

Key words

screening - lung cancer - COPD - CAPTURE - NELSON

• Literatur

• 1 Steppuhn H, Kuhnert R, Scheidt-Nave C. 12-Monats-Prävalenz der bekannten chronisch obstruktiven Lungenerkrankung (COPD) in Deutschland. Journal of Health Monitoring 2017; 2: 46-54 . doi:10.17886/RKI-GBE-2017-053
• 2 Wacker ME, Jörres RA, Schulz H. et al. Direct and indirect costs of COPD and its comorbidities: Results from the German COSYCONET study. Respir Med 2016; 111: 39-46 . doi:10.1016/j.rmed.2015.12.001
• 3 Çolak Y, Afzal S, Nordestgaard BG. et al. Prognosis of asymptomatic and symptomatic, undiagnosed COPD in the general population in Denmark. A prospective cohort study. The Lancet Respiratory Medicine 2017; 5: 426-434 . doi:10.1016/S2213-2600(17)30119-4
• 4 Martinez FJ, Mannino D, Leidy NK. et al. A New Approach for Identifying Patients with Undiagnosed Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2017; 195 (06) 748-756 . doi:10.1164/rccm.201603-0622OC
• 5 Aaron SD, Tan WC, Bourbeau J. et al. Diagnostic Instability and Reversals of Chronic Obstructive Pulmonary Disease Diagnosis in Individuals with Mild to Moderate Airflow Obstruction. Am J Respir Crit Care Med 2017; 196 (03) 306-314 . doi:10.1164/rccm.201612-2531OC
• 6 Lange P, Celli B, Agustí A. et al. Lung-Function Trajectories Leading to Chronic Obstructive Pulmonary Disease. N Engl J Med 2015; 373 (02) 111-122 . doi:10.1056/NEJMoa1411532
• 7 Woodruff PG, Barr RG, Bleecker E. et al. Clinical Significance of Symptoms in Smokers with Preserved Pulmonary Function. N Engl J Med 2016; 374 (19) 1811-1821 . doi:10.1056/NEJMoa1505971
• 8 Harvey BG, Strulovici-Barel Y, Kaner RJ. et al. Risk of COPD with obstruction in active smokers with normal spirometry and reduced diffusion capacity. Eur Respir J 2015; 46 (06) 1589-1597 . doi:10.1183/13993003.02377-2014
• 9 Regan EA, Lynch DA, Curran-Everett D. et al. Clinical and Radiologic Disease in Smokers With Normal Spirometry. JAMA Intern Med 2015; 175 (09) 1539-1549 . doi:10.1001/jamainternmed.2015.2735
• 10 Galbán CJ, Han MK, Boes JL. et al. Computed tomography-based biomarker provides unique signature for diagnosis of COPD phenotypes and disease progression. Nat Med 2012; 18 (11) 1711-1715 . doi:10.1038/nm.2971
• 11 Statistisches Bundesamt. Gesundheit, Todesursachen in Deutschland 2015. Im Internet: https://www.genesis.destatis.de ; Stand: 01.07.2019
• 12 Morgensztern D, Ng SH, Gao F. et al. Trends in stage distribution for patients with non-small cell lung cancer: A National Cancer Database survey. J Thorac Oncol 2010; 5 (01) 29-33 . doi:10.1097/JTO.0b013e3181c5920c
• 13 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF). Prävention, Diagnostik, Therapie und Nachsorge des Lungenkarzinoms, Langversion 1.0, 2018, AWMF-Registernummer: 020/007OL. http://leitlinienprogramm-onkologie.de/Lungenkarzinom.98.0.html (Zugriff am: 16.07.2019)
• 14 Manser R, Lethaby A, Irving LB. et al. Screening for lung cancer. Cochrane Database Syst Rev 2013; 6: CD001991 . doi:10.1002/14651858.CD001991.pub3
• 15 De Koning HJ. NELSON Study Shows CT Screening for Nodule Volume Management Reduces Lung Cancer Mortality by 26 Percent in Men [Abstract]. Im Internet: https://wclc2018.iaslc.org/media/2018%20WCLC%20Press%20Program%20Press%20Release%20De%20Koning%209.25%20FINAL%20.pdf ; Stand: 16.07.19 (zusätzlich persönliche Kommunikation)
• 16 Perisinakis K, Seimenis I, Tzedakis A. et al. Radiation burden and associated cancer risk for a typical population to be screened for lung cancer with low-dose CT: A phantom study. Eur Radiol 2018; 28 (10) 4370-4378 . doi:10.1007/s00330-018-5373-7
• 17 Oudkerk M, Devaraj A, Vliegenthart R. et al. European position statement on lung cancer screening. The Lancet Oncology 2017; 18 (12) e754-e766 . doi:10.1016/S1470-2045(17)30861-6
• 18 Calabrò E, Randi G, La Vecchia C. et al. Lung function predicts lung cancer risk in smokers: A tool for targeting screening programmes. Eur Respir J 2010; 35 (01) 146-151 . doi:10.1183/09031936.00049909
• 19 Seijo LM, Zulueta JJ. Understanding the Links Between Lung Cancer, COPD, and Emphysema: A Key to More Effective Treatment and Screening. Oncology 2017; 31 (02) 93-102