Lung cancer screening

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Lung cancer is one of the most common cancers in the UK but outcomes are consistently poor. Across the health sector, there is a keen desire to improve lung cancer outcomes, but this is complex and needs to be tackled in many different ways.

There isn’t a national screening programme for lung cancer in the UK at the moment. But over the past few years there has been continued interest in whether it’s possible to reduce the number of lung cancer deaths through targeted lung screening.  Targeted screening is screening that’s directed towards certain people on the basis of more than their age.

A large trial has been going on in Europe (NELSON) using low-dose CT scans to screen individuals at increased risk of developing lung cancer. This data points to a mortality reduction in high-risk individuals who received a low-dose CT scan.  You can read more about the history of lung cancer screening research and the NELSON trial in this blog post.

The UK National Screening Committee (UK NSC) will now review the data from NELSON and other sources. The UK NSC make recommendations for screening based on various criteria, including clinical and cost-effectiveness. They will only recommend a screening programme if it’s clear that the benefits outweigh the harms and that the programme will be cost-effective at a population level.

The UK NSC has focused on making decisions about population screening, but Professor Sir Mike Richards’ screening review has recommended that a single decision-making body be established that considers both population and targeted/risk-based screening, such as lung cancer screening. We are awaiting further information about how this will be taken forward.

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Statistics for lung cancer which show outcomes are consistently poor

NELSON trial results

NELSON trial history

Professor Sir Mike Richards’ screening review

Several local targeted lung screening projects were set up under the Accelerate, Coordinate, Evaluate (ACE) initiative[1].

More recently, NHS England has funded targeted screening projects (Lung Health Checks) in ten cancer alliances across England as part of the Long Term Plan. These projects aim to support improved outcomes for lung cancer and are being rolled out initially in areas where incidence and mortality of lung cancer are very high in the target population [2].

The NHS England Targeted Lung Health Check (TLHC) projects will be delivering to a standard protocol that includes the provision of smoking cessation. Other materials relating to the projects are also available.

The projects will involve identifying people aged between 55 and 74 who are recorded in their GP practice record as having smoked. These people will then be invited for a Lung Health Check, where there will be further assessment of their risk of lung cancer, as well as spirometry, and smoking cessation support for those who need it. Those identified as being above a certain level of future lung cancer risk based on one or both of two different risk assessment models will be invited to have a low dose CT scan. This may take place on the same day, or at a later date.

These projects are an important opportunity to learn more about how a targeted lung screening programme could be implemented in the NHS, should the decision be made to scale it up to a national programme. It is crucial that these projects are done to a high standard and evaluated robustly. These projects also offer a valuable and specific research opportunity to address some outstanding questions about lung screening.

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Accelerate, Coordinate, Evaluate (ACE)

NHS Long Term Plan

TLHC standard protocol

TLHC other materials

References

  1. ACE. Proactive approaches to individuals at high risk of lung cancer. February 2018.
  2. CRUK blog. NHS to roll out mobile lung cancer scanning across England. February 2019.

As well as the projects funded as part of the NHS England TLHC programme, there is also other activity happening in the NHS such as in Manchester and Liverpool, where eligible members of the local population are being invited to attend a lung health check.

There is also ongoing research activity, including the Yorkshire Lung Screening Trial which is adding to the evidence base around the feasibility of a lung screening programme and SUMMIT which aims to evaluate a blood test designed to detect multiple types of cancer, including lung cancer.

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Activity in Manchester

Activity in Liverpool

Yorkshire Lung Screening Trial

SUMMIT

At the moment targeted lung screening is only available in certain parts of England and is not offered across the devolved nations, but there is interest in seeing what might be possible in the future. On top of this, even in areas with activity not everyone will be invited to a lung health check, and not all attendees will meet the threshold for receiving a low dose CT scan.

Tobacco exposure remains the biggest risk factor for lung cancer and smoking cessation, and tobacco control efforts must be continued.

However, lung cancer can also be diagnosed in non-smokers and it’s crucial to remain alert to the risk of lung cancer in all patients to make sure that everyone who develops lung cancer has the best chance of a good outcome.

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Smoking cessation guidance

About lung cancer

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