Abstract 3631: United Kingdom lung cancer screening trial (UKLS): First 88897 approaches.

Abstract

The UK Lung Cancer Screening trial (UKLS) aims to inform decision makers about the desirability of introducing lung cancer population screening in the UK, and to assess mortality and cost effectiveness. The UKLS pilot started recruitment in 2011 at the Liverpool Heart & Chest Hospital and Papworth Hospital, Cambridge. 250,000 individuals were approached, of whom 4000 were identified as at high risk of lung cancer by the Liverpool Lung Project (LLP) validated Risk Prediction Model. Participants randomised to the study arm have a single low dose computed tomography (CT) scan; controls have usual care. We now have data from the first 88,897 people approached. 26.8% responded to the first recruitment questionnaire (‘positive responders’), of whom 12% had a LLP risk score <5% risk of lung cancer over 5 years. 65% of these high risk individuals agreed to participate in the trial. 9.7% of the 88,897 approached provided some basic information but did not wish to participate (‘negative responders’), while 63.5% were non-responders. On examining the age distribution, the 50-55 age group were the least likely to participate and, when they did, practically all had a LLP risk score <5%. The UK Index of Multiple Deprivation score (IMD) was available on 88,896 individuals. Higher socioeconomic status correlated positively with response rate, but inversely with LLP risk score. High risk recruits spanned all national quintiles of IMD in proportion to the approached subjects. Within each IMD quintile, no significant differences in response rate or recruitment were seen between the Liverpool and Cambridgeshire populations, although the overall social demographics of the two areas are quite different, with much more deprivation in Liverpool. Among the positive responders (n=23,794), 45% were never smokers, 14% smokers and 40% were ex-smokers (compared with national figures [all ages] of 54%, 21% and 25% respectively; p<0.0001). Only four high risk individuals were identified amongst the never smoking positive responders (0.04%; none of whom attended clinic). 32.7% of current smokers and 18.4% of ex-smokers were designated high risk. Overall, 6.1% of positive responders were deemed high risk and attended a recruitment clinic. Of the smoking and ex-smoking positive responders (3345 and 9520 respectively), 22.1% were high risk, and 11.3% attended clinic and were recruited into the RCT. UKLS is the first CT screening RCT to select high risk people using a validated risk prediction model at a population level. Only 5% of clinic attendees were 60 or younger (compared to 47% of all 88,897 approached); this may have implications for cost effectiveness of CT screening. As expected, very few never smokers were at high risk. The response rate and clinic attendance is better in ex-smokers than in current smokers. An understanding of the factors influencing high risk individuals’ uptake of CT screening will be important in developing future CT screening programmes, if adopted. Citation Format: John K. Field, David Baldwin, Anand Devaraj, Kate Brain, Tim Eisen, John Holemans, Martin Ledson, Nicholas Screaton, Robert C. Rintoul, Ghasem Yadegarfar, Chris Hands, Fiona E. McRonald, Kate Lifford, David Whynes, Keith Kerr, Richard Page, Mahesh Parmar, David Weller, David Whynes, Paula Williamson, David Hansell, Stephen W. Duffy. United Kingdom lung cancer screening trial (UKLS): First 88897 approaches. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3631. doi:10.1158/1538-7445.AM2013-3631

The role of screening expectations in modifying short–term psychological responses to low-dose computed tomography lung cancer screening among high-risk individuals

“…This follow-up group included those who were positive for a repeat scan (at 3 or 12 months) or positive for an MDT referral due to a major lung abnormality. (For more details about classification of test results, see Field et al [11,22] and Brain et al [17]). Those with a "negative with incidental finding" result were excluded from the sample because of the wide range of incidental findings, hence difficult to categorise further [17].…”

“…UKLS is a multicentre randomised controlled pilot trial to compare LDCT screening versus usual care, for the early detection of lung cancer, in high-risk individuals [11,[20][21][22].…”

“…High-risk participants were defined as at >5% estimated risk over five years of developing lung cancer according to the Liverpool Lung Project Risk Prediction Model [11]. Only those in the intervention arm were included in the present study.…”

“…Results Figure 1 shows study participation and response rate. Of a total of 4055 individuals randomised, 2028 were assigned to the intervention arm (LDCT scan) of which 1994 were scanned and included in the UKLS CT scan arm [22]. While 1994 participants in the intervention arm were scanned, 1653 completed questionnaires at both T0 and T1 and were included in the main psycho-social analysis [17], and after making further exclusions (details in Figure 1), data from 1589 participants were in the final sample.…”

“…A number of screening trials for early detection of lung cancer have been or are being conducted [10]. The UKLS pilot trial used LDCT screening in a high-risk sample and showed that it is possible to detect cancer at an early stage and deliver potentially curative treatment to a large proportion of identified cases [11]. The US-based National Lung Cancer Screening Trial (NLST) showed a 20% reduction in lung cancer-related mortality in those at high risk when comparing LDCT screening with chest radiography [12].…”