Lung cancer screening
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.
Lung cancer is the most common cause of cancer death in the UK, and survival from lung cancer remains low. One reason for this is that people are often diagnosed at a late stage, where there are fewer treatment options available.
On 29 September 2022, the UK National Screening Committee (UK NSC) recommended introducing a targeted lung cancer screening programme across the UK, for those at high risk of the disease. The targeted lung cancer screening programme is new. So, it’s likely that it will take some time before this is available for everyone.
What is targeted screening?
Targeted screening is directed towards certain people on the basis of more than their age. The UK NSC recommends:
- inviting people aged 55-74 who either smoke, or used to smoke, to an initial assessment.
- smoking cessation services should be an integral part of the screening programme.
The initial assessment will involve a health professional asking some questions to determine if someone is at a high risk of lung cancer. If they are, they will then be offered a low dose CT scan of the lungs.
A low dose CT scan helps to check for changes in the lungs that may be lung cancer. The scan uses x-rays and a computer to create detailed pictures of the lungs from different angles to form a 3D image. If somebody has suspected lung cancer, they will be referred so it can be diagnosed as soon as possible. If other abnormalities are found, they may be invited to screening more regularly.
The UK NSC review included data from a large trial that 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.
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Several local targeted lung screening projects were set up under the Accelerate, Coordinate, Evaluate (ACE) initiative [1].
NHS England funded targeted screening projects (Lung Health Checks) in 14 areas across England as part of the Long Term Plan. These projects aimed 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]. These have since been rolled out in 23 areas. These services are still going ahead while the national targeted screening programme is being introduced.
There are no Lung Health Checks taking place in Scotland, Wales and Northern Ireland at the moment, however there is scoping activity taking place.
The NHS England Targeted Lung Health Check (TLHC) projects are being delivering to a standard protocol that includes the provision of smoking cessation. Other materials relating to the projects are also available.
The targeted lung health check projects:
| Identify people aged between 55 and 74 who are recorded in their GP practice record as having smoked. | |
| Invite them 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 gather evidence and learning about how a targeted lung screening programme can be implemented in the NHS. 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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References
- ACE. Proactive approaches to individuals at high risk of lung cancer. February 2018.
- 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 people in 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.
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. However, CRUK have created a ‘GP Insight for Scotland’ resource to support Scottish GPs to diagnose lung cancer early. 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, smoking cessation and tobacco control efforts must be continued. CRUK have pulled together the evidence, training and practical resources to support health professionals in their role to advise people how to quit and about the options available to them. See more information here.
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.
About lung cancer