Thank you for the invitation. And I was so glad when I came inside here and see this full room. Like, you know, 10, 20 years ago, when we talk about screening, it was not that kind of full room. So it's amazing how this subject is growing. And I remember, David, first time when I spoke with Claudia in 2007 in Boston when I met her. And I was leaving there and say, what's going on in South America about screening? And she said, not that much. It was 2007. I was leaving the US since 2001. And then Claudia, and I asked her, how we should start? If I call my friends or if I go back? She said, just start with 1,000. Because she had that publication in Lancet with 1999. And she said, do you find numbers to start? And that talk, I was thinking about, since that day, how to start in Brazil. And I decided to go back to Brazil in 2010. And I put a lot of things here to follow, to read. But when I decide to, and I say, it's better to speak spontaneously if you want to talk to someone and be understood. And I think life is about being understood and don't be alone. And that talk with Claudia was meaningful. Because when I went back and say, we're not alone trying to do this crazy thing about doing Lancet screening. So I decided to go back to Brazil in 2010, 2009. And first of all, I need to say thank you to all this foundation. That's financial acknowledgments here. Bristol MedSquib is giving us a big support for this mobile unit in Brazil. AstraZeneca, we were talking, the CICAS came here with the long ambition. So many others, the Etican giving us support for the medical devices. And I think don't be alone and be understood and being supportive means to say thank you for all the support that we are having in Brazil to start programs of Lancet screening. So our history, I didn't know about back in 2013 or even after. But we met in Boston lately. And I was looking at the lung health check back in there. Because after the 2011 publication in New England, we decided to do this in Brazil as an implementation research. It's still on the implementation research aspect. But we could publish. We went to national TV together with this nonprofit institution and supported by the federal government. The federal grant was able to start not with 1,000, David. The plan was 1,000. But we could go until 800. And then we published the first screening trial in Brazil with 790. Same numbers that we saw here. 1.7% of prevalence, 3% of lung biopsies. And our doubt is if tuberculosis will be a problem. Unfortunately, Brazil, we still have tuberculosis. Too many nodules. But it was not a problem. Sometimes I see in presentations, people talking about tuberculosis and quote my paper as a paper. Say, oh, granulomatosis could be a problem. I say, this is exactly what the paper is denying. And we could do the same number of biopsies, 3%, and find the same numbers of cancers of NLSC. We work as an arm of NLSC. It was not part of the work. But we did the same criteria, 55 to 74. And then we started talking about education. This is something we started in 2018 called Propamon 360, inspired by the IOCAP. Because I saw there IOCAP doing meetings every six months about lung cancer screening. All about lung cancer screening. And I was so impressed by the IOCAP. I say, let's do something like this. And I was, again, proud to be holding the first IOCAP meeting in Brazil in 2019 with Claudio, David, and the whole group from Monsa and I. Helping us, not only from the beginning in 2013, but also giving us new tools, new instruments to keep improving or trying to be better on lung cancer screening in Brazil. So we had that horrible pandemic scenario in 2020. We didn't stop. We did telemedicine. Of course, the lung cancer screening was not happening back in there. But we are doing webinars with many of you present on those webinars back in there. At that time, we put together. We tried to help many institutions. So this is not a work of one single institution. I'm not here representing one or other institution in Brazil. I'm actually talking about several institutions trying to do lung screening together. And then, of course, separate in terms of financial or administration. But then we put the data together in 2022. And then we published the BRELT-2, which was the second trial after all that working. I will be talking about this in the other meeting, in the other room tomorrow. But we see with 2,000, almost 3,500 patients, the same numbers again. Institutions in different regions, institutions doing CAT scans, 1,500, 400 CAT scans, we found again the same numbers. 2% of prevalence of lung cancer. The stage shift was about 80% in stage one or two. Still finding lung cancer in more advanced stages. We can discuss this during this talk here later. And then I had that call. Patricia Duikos was before Catherine Grimes. And Catherine is here. And when I have that call and say, how did you find me? And I said, because you publish things. I see your papers. As I saw yours, John Field. And I said, and she said, I want to support your work in Brazil. And let's talk about it. And then based on your work, Ravel, based on your work, John, I said, let's put a mobile unit in Brazil. I had no idea how to do it. No idea. No idea. Let's talk about the guys who did first. I didn't know you, Melissa, before. But I could call you. And I saw folks from South Brazil doing in Baredas, getting the CAT scan from Netherlands. I just said, it's too expensive. Let's find someone that could do the mobile over here. And found a group in Brazil and put together this mobile unit to do 3,000 CAT scans. I'll talk in the next three minutes about the mobile unit. And in 2024, led by the Brazilian Thoracic Society, the Brazilian College of Radiology, and the Pulmonary Brazilian Society, the first national recommendations of lung cancer screening came out. And that was very meaningful, because now we have the medical societies in Brazil giving support. We don't have, as in Japan, until now, any national program or a federal official support. But we have the medical societies already together doing recommendations on lung screening. This is our unit, built with the support of many companies. But the first I mentioned here, Bristol, is our main supportive company. And it's like an IoT machine. Send the image to the cloud. And then we do, by telemedicine, all the reports. This is located in northeast Brazil. I don't know if you know my country, but I live here by the coast in Salvador. And this is the northeast. This is the north of the Amazon forest. It's located together with other countries. And to have a better idea for the environment of my city, of course, I'll give you this picture. This is the unit travel in the oceans part. And then we travel 200, 300 miles in inner cities of the northeast. And this is the inside of the truck. You can open. It's not like three trucks together. I was thinking about the next step. We can talk about this. And this is the CAT scan inside. You have different rooms that you can do interview and all the tomography. I'll just run here. And this is me talking to the city hall folks in different cities, websites. The PROPOMO is a website for this implementation research. I'm here with one of the pulmonary physicians and many coordinators from the city hall. This is the health city health secretary in one of the cities in Feira de Santana. And this is the scenario that after the CAT scan, one of our surgeons talking to all the participants who had Langerhans 1 and 2. It would be too much expensive to get a doctor in front of a person with Langerhans 1 and 2. So I put, like here, 50, 60 together. No signs of the CAT scan, no symptoms before. I can talk for an hour about those findings. And people are happy with that. And the finish here, if you see, this is the way that we go. If you are 50 or older, come over. Then we apply the PLCO and the NLCT criteria. Not the PLCO is not for doing the CAT scan, but we apply to know the population. Langerhans 1 and 2, as I mentioned here, if you have symptoms or if you have findings, and unfortunately, it's not about only lung cancer. This is one of the findings here. This is for sure a person who had tuberculosis, but denied symptoms. And then have to have pulmonary physicians talk to them and doing the follow up for these findings. People without symptoms and all these findings. But we see also big mess like that. And then we do the screen board, which is a multidisciplinary virtual committee meeting where we can talk about the findings. And we do something like this. We have pulmonary radiologists, surgeons, and oncologists together. They vote before the meeting. When you go to the meeting, they already saw the CAT scan before. And if there is an agreement of 70% or more, we can go to the next case. If there is no agreement, we open up all the image to discuss and have a better decision on the multidisciplinary board. And this is our results so far. This is just to show here quickly. 2,000 CAT scans done. This is the cities that we are working here. Salvador, as I showed here. The city is 200 miles away. And then how long you smoke, number of cigarettes, the pack years, the age range, and everything. We've been talking this in the early detection committee to have this data better analyzed. And here, light reds, one, two, three as yellow, and four in orange or red. We have so far 99 light reds, four. And this is probably my final slide. Project meeting with the state health secretary and talking about follow up for these patients because we have the grant. We have the support. But all the patients need to be followed by the public system. This is the cases that we did surgery so far. You see small nodules, but this one, a little bit bigger, is already done. This one is about to do the biopsy, just for an example. And then we do this task force to do cases all together. And workshops, the proper amount, the knowledge of lung CT screening is increasing when you do a meeting. This is before the meeting. This is after the meeting, the screening getting in people's mind. And the support of the Lung Cancer Policy Network has been very important for us. And I know that Sebastian is also here and will be talking about, because we are in this website and I appreciate all the support and not be alone. This is the results, similar to the National-International. Delaying biopsy is very worthsome for us and we need better medical healthcare integration to minimize the delay and justify the implementation of screening program in Latin America. This is my contact here. And this is, I sent this to Shat GPT, my presentation, and say, bring up a sentence that what you saw, and this is made by artificial intelligence. They said, lung cancer screening not only save lives, but also empowers communities with the knowledge and tools to protect their respiratory health. By bridging gaps in access and diagnosis, we are shaping a future where early detection becomes a cornerstone of preventive care in Latin America. I convinced the artificial intelligence. I hope that I can convince you too. Thank you very much. Thank you, Dr. Sandhoff.

lung cancer screening

Brazil

mobile unit

educational initiatives

national recommendations