Cassandra, a pilot program to 'search' for patients suffering from respiratory diseases

The entire process of undergoing a low-dose CT scan of the chest takes just over 30 minutes.. And through the images a specialist can know if there is a trace of cancer, any respiratory pathology lodged in the bronchi, damage to the heart and any other anomaly in that region.. A test that could be performed on patients with a defined risk and save their lives.

The Cassandra pilot project will certify that this is possible. And yes, as its coordinators assure, it is an ambitious plan, “but necessary to get ahead of the disease”. “It is entered into the patient: we contextualize through cancer and other risk diseases. What is pursued is early detection,” explains Juan Carlos Trujillo, clinical head of the Thoracic Surgery Service at the Santa Creu i Sant Pau Hospital in Barcelona and coordinator of the Cassandra project..

But not only that. With this pilot program we also want to instrumentalize help with smoking cessation. “Primary prevention [quitting tobacco] has not worked, that is why we need other tools to help us,” Trujillo emphasizes..

Madrid, as confirmed this week by its Minister of Health, is now giving the starting signal to its participation in the Cassandra project. “We have supported it from minute one, because it is a pilot project for lung diseases, not just cancer”.

Matute highlighted the work led by the Spanish Society of Pulmonology and Thoracic Surgery (Separ) together with nine scientific societies. “In Madrid it will help us export the idea of units in all our centers,” said Matute.. For now, La Paz, Ramón y Cajal and Clínico have been included. “Although more could be added”.

In this way, “a domino effect occurs and we will be able to implement the pilot in 12 centers. It is almost ready in other Autonomous Communities. At the end of 2028 we hope to have the results,” explains Trujillo.. It is expected that all the autonomies will get on board to have a faithful reflection of Spanish society, at least up to 40 centers that can perform a total of between 40-30,000 scans in total.

Trujillo stressed the importance of the project being implemented in the National Health System in line with the recommendations of the European Plan to Fight Cancer.. “This will help us to enter the portfolio of services such as screening tests,” said the pulmonologist.. Matute added that “every advance in the prevention of the disease is an opportunity for action”.

Ángel Gallete, secretary of the Cassandra de Separ project, points out that “this is necessary because lung tumors are found in increasing numbers.”. 70% are detected in advanced stages and five-year survival is 5%. However, we know that this increases the sooner it is detected [up to 80%]”.

In our country, more than 29,000 new cases of lung cancer are diagnosed every year and one person dies from this cause every 20 minutes.. It has been shown that screening with low-dose CT allows early detection of lung cancer in early stages and reduces mortality in randomized clinical trials with large sample sizes carried out in Europe and the United States..

Luis Miguel Seijo Maceiras, co-director of the Cassandra Project and coordinator of Separ, explained that “the test of choice is low-dose computed tomography: it is a radiological test, with a degree of recommendation just like mammography in breast cancer.”.

The Cassandra project, which responds to the acronym Cancer Screening, Smoking Cessation and Respiratory Assessment, takes into consideration that there are aspects of screening with a significant impact on effectiveness, feasibility and cost-effectiveness..

At the moment, the risk profile is by age and smoking habit, between 50 and 75 years old with a specific smoking burden.. “But we are open to verifying that we should include new features as we have more experience,” Gallete emphasizes.

“We have taken important steps in reducing false positives. And we will compose a refined strategy to search for significant damages. For that we have incorporated new knowledge, and in this way we reduce the negative effects,” says Seijo..

Test Safety: Low Dose CT

“Among the advantages of low-dose radiation chest computed tomography, we must highlight that it is a simple, quick, painless and comfortable test to perform,” explains Luis Gorospe, specialist at the Spanish Society of Medical Radiology (Seram). , thoracic radiologist at the Ramón y Cajal University Hospital and member of the scientific committee of the Cassandra project.

The administration of intravenous contrast is not required to perform it.. In addition, it uses much less radiation than a “conventional” computed tomography study, even in many cases comparable to a chest x-ray..

This test is “the best diagnostic tool for studying the lung, and in addition to detecting lung nodules, it also allows us to evaluate calcifications of the arteries, the presence of pulmonary emphysema or whether a person has osteoporosis,” says Gorospe..