Real World Data on Lung Cancer Screening in the UK

Dawn O'Shea

August 11, 2020

Real world UK data show that lung cancer screening (LCS) may be less harmful and more cost-effective than has been seen in previous larger studies, according to a study published in Thorax.

The randomised controlled Lung Screen Uptake Trial evaluated the effect of targeted, stepped and low burden invitations on attendance at a lung health check (LHC). Current smokers aged 60-75 years were invited to an LHC by their usual GP. Those meeting any of the following criteria were offered a single low-dose computed tomography on the same day (or later if preferred): ≥30 pack-years or had quit ≤15 years ago or a lung cancer risk of ≥1.51 per cent or ≥2.5 per cent as determined by the Prostate, Lung, Colorectal and Ovarian study or the Liverpool Lung Project models, respectively.

Three-quarters (75.0%) of lung cancers detected were early stage, and 79.4 per cent of patients with non-small cell lung cancer had treatment with curative intent, slightly lower than in the UK Lung Cancer Screening Trial (UKLS), which may reflect the population screened.

Indeterminate pulmonary nodules for three-month and 12-month surveillance were detected in 11.9 per cent and 4.3 per cent of the participants, respectively, and cancer was detected in 4.7 per cent.

The rate of indeterminate pulmonary nodules (16.2%) was lower than in the UKLS (24.2%) and NELSON trial (19.2%). This may be due to the implementation of the 2015 BTS pulmonary nodule guidelines.

The number of invasive tests for those without lung cancer was low, with only 4 per cent of individuals having a positron emission tomography-computed tomography scan or other invasive tests.

“From these findings, as well as the impressive early-stage disease and curative intent treatment rates observed, we propose that LCS in a ‘real-world’ setting may be less harmful, more efficient and more cost-effective than has been seen in larger LCS studies,” the authors concluded.

Ruparel M, Quaife SL, Dickson JL, Horst C, Tisi S, Hall H, Taylor M, Ahmed A, Shaw P, Burke S, Soo MJ, Nair A, Devaraj A, Sennett K, Duffy SW, Navani N, Bhowmik A, Baldwin DR, Janes SM. Lung Screen Uptake Trial: results from a single lung cancer screening round. Thorax. 2020 Aug 5 [Epub ahead of print]. doi: 10.1136/thoraxjnl-2020-214703. PMID: 32759387.  Full text.

This article originally appeared on Univadis, part of the Medscape Professional Network.

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