Category: Oncology Imaging

Screening Takes Center Stage at ECR 2025

Posted on by Brian Casey

New advances in cancer screening were among the major trends at last week’s ECR 2025 conference in Vienna. From traditional screening exams like mammography to up-and-coming tests like CT lung cancer exams, radiologists are emerging at the forefront of efforts to improve population health through early detection.

CT lung cancer screening is gaining momentum in Europe, and a Friday afternoon session explored the experiences of multiple sites…

  • U.K. researchers used DeepHealth’s Lung Nodules AI solution for automated triage of lung nodules found on non-screening CT chest exams, finding the approach could save £25k-£37k annually.
  • A German team documented technical lung CT acquisition parameters for screening centers in the SOLACE consortium across 10 countries, finding some room for improvement. 
  • Preliminary results from an Italian lung screening project were reported, with 2k people scanned with a 1.5% cancer detection rate (77% stage I-II) and 17% recall rate. Smoking cessation advice was also given.
  • Early results from a pilot screening project in Poland were given, with a 1.9% cancer detection rate in 3.1k people screened. They recommend screening be implemented nationwide. 
  • In a secondary analysis of 23.4k people in the NLST study, CT-derived body composition metrics predicted mortality beyond traditional risk factors.

Meanwhile, new ECR cancer screening research builds on the landmark accomplishments from 2024 in AI for breast screening. A Saturday afternoon session explored the progress being made…

  • German breast screening programs that deployed ScreenPoint Medical’s Transpara AI algorithm for 119k women saw their cancer detection rate grow (6 vs. 4.8 cancers per 1k) while the recall rate remained stable at around 2.5%. 
  • AI-supported double-reading in Italy for 120k women led to more breast cancers detected on baseline exams compared to subsequent screening rounds, as well as a 42% lower recall rate.
  • Patients found an AI chatbot based on GPT-4 generated responses to their questions that were more empathetic and readable than those of radiologists.
  • Another Italian study found that using AI for double-reading mammograms of 266k women led to a 21% increase in cancer detection rate and 15% drop in recall rate.
  • A secondary analysis of the MASAI trial suggested that double-reading with two radiologists continue to be used for high-risk women. Single reading of 3.8k high-risk exams resulted in 8.9% fewer detected cancers and 5.9% fewer recalls.

The Takeaway

Last week’s research on cancer screening at ECR 2025 shows that imaging experts see screening as a way to not only improve population health on a broad scale, but also to give radiologists the opportunity to raise their profile with patients and take a more direct role in patient care. The question is whether it’s an opportunity radiologists are ready to take.

Screening Foes Strike Back

Posted on by Brian Casey

Opponents of population-based cancer screening aren’t going away anytime soon. Just weeks after publication of a landmark study claiming that cancer screening has saved $7T over 25 years, screening foes published a counterattack in JAMA Internal Medicine casting doubt on whether screening has any value at all. 

Population-based cancer screening has been controversial since the first programs were launched decades ago. 

  • A vocal minority of skeptics continues to raise concerns about screening, despite the fact that mortality rates have dropped and survival rates have increased for the four cancers targeted by population screening.

This week’s JAMA Internal Medicine featured a series of articles that cast doubt on screening. In the main study, researchers performed a meta-analysis of 18 randomized clinical trials (RCTs) covering 2.1M people for six major screening tests, including mammography, CT lung cancer screening, and colon and PSA tests. 

  • The authors, led by Norwegian gastroenterologist Michael Bretthauer, MD, PhD, concluded that only flexible sigmoidoscopy for colon cancer produced a gain in lifetimes. They conclude that RCTs to date haven’t included enough patients who were followed over enough years to show screening has an effect on all-cause mortality.

But a deeper dive into the study produces interesting revelations. For CT lung cancer screening, Bretthauer et al didn’t include the landmark National Lung Screening Trial, an RCT that showed a 20% mortality reduction from screening.

  • With respect to breast imaging, the researchers only included three studies, even though there have been eight major mammography RCTs performed. And one of the three included was the controversial Canadian National Breast Screening Study, originally conducted in the 1980s.

When it comes to colon screening, Bretthauer included his own controversial 2022 NordICC study in his meta-analysis. 

  • The NordICC study found that if a person is invited to colon screening but doesn’t follow through, they don’t experience a mortality benefit. But those who actually got colon screening saw a 50% mortality reduction.  

Other articles in this week’s JAMA Internal Medicine series were penned by researchers well known for their opposition to population-based screening, including Gilbert Welch, MD, and Rita Redberg, MD.

The Takeaway

There’s an old saying in statistics: “If you torture the data long enough, it will confess to anything.” Among major academic journals, JAMA Internal Medicine – which Redberg guided for 14 years as editor until she stepped down in June – has consistently been the most hostile toward screening and new medical technology.

In the end, the arguments being made by screening’s foes would carry more weight if they were coming from researchers and journals that haven’t already demonstrated a longstanding, ingrained bias against population-based cancer screening.

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