Defining the road map to a UK national lung cancer screening programme

O’Dowd, Emma; Lee, Richard W.; Akram, Ahsan; Bartlett, Emily; Bradley, Stephen H; Brain, Kate; Callister, Matthew; Chen, Yan; Devaraj, Anand; Eccles, Sinan R.; Field, John K.; Fox, Jesme; Grundy, Seamus; Janes, Sam M.; Ledson, M.J.; Mackean, Melanie; Mackie, Anne; McManus, Kieran; Murray, Rachael L; Nair, Arjun; Quaife, Samantha L; Rintoul, Robert C.; Stevenson, Anne; Summers, Yvonne; Wilkinson, Louise; Booton, Richard; Baldwin, David R; Crosbie, Philip

doi:10.1016/s1470-2045(23)00104-3

Cited by 22 publications

(5 citation statements)

References 76 publications

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Section: Introductionmentioning

confidence: 99%

“…People aged 55-74 with a GP health record documenting a smoking history will be invited to interview for a risk assessment, after which they may be offered a low-dose CT (Computed Tomography) scan. Focussing on those with the highest risk will enable earlier diagnosis and potentially better survival, with reduced iatrogenic harm from screening-related radiation exposure [14], [15]. Due to changes in risk factor exposure, and the introduction of the new screening in 2023, a comprehensive assessment of the trends of lung cancer in different population strata using routinely collected data from primary care, is required in the UK.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Incidence, prevalence, and survival of lung cancer in the United Kingdom from 2000-2021: a population-based cohort study

Corby,

Barclay,

Tan

et al. 2024

Preprint

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BackgroundLung cancer is the leading cause of cancer-associated mortality worldwide. In the UK, there has been a major reduction in smoking, the leading risk factor for lung cancer, as well as the introduction of the new screening in 2023. Therefore, an up-to-date assessment of the trends of lung cancer is required in the UK.MethodsWe performed a population-based cohort study using the UK primary care Clinical Practice Research Datalink (CPRD) GOLD database, compared with CPRD Aurum. Participants aged 18+ years, with one-year of prior data availability, were included. We estimated lung cancer incidence rates (IR), period prevalence (PP), and survival at one-, five– and ten years after diagnosis using the Kaplan-Meier method.ResultsOverall, 11,388,117 participants, with 45,563 lung cancer cases were studied. The incidence rate of lung cancer was 52.0 (95% CI 51.5 to 52.5) per 100,000 person-years, with incidence increasing from 2000 to 2021, especially in females aged over 50, and males aged over 80, with the highest incidence rate in people aged 80-89. Period prevalence in 2021 was 0.18%, with the largest rise seen in participants aged over 60. Median survival post-diagnosis increased from 6.6 months in those diagnosed between 2000-2004 to 10 months between 2015-2019. Both short and long-term survival was higher in younger cohorts, with 82.7% one-year survival in those aged 18-29, versus 24.2% in the age 90+ cohort. Throughout the study period, survival was longer in females, with a larger increase in survival over time than in males.ConclusionThe incidence and prevalence of lung cancer diagnoses in the UK have increased, especially in female and older populations, with a small increase in median survival. With the introduction of the UK lung cancer screening programme, this study will enable future comparisons of overall disease burden, so the overall impact may be seen.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incidence, prevalence, and survival of lung cancer in the United Kingdom from 2000-2021: a population-based cohort study

Corby,

Barclay,

Tan

et al. 2024

Preprint

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“…In 2022, the UK National Screening Committee recommended that all four nations implement targeted screening for lung cancer [ 7 ]. Whilst The Targeted Lung Health Checks programme currently running in England is a good starting point, and implementation is underway in some places, screening is not yet a national programme and more work is needed to achieve this [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Health Economic Evaluation of Lung Cancer Screening Using a Diagnostic Blood Test: The Early Detection of Cancer of the Lung Scotland (ECLS)

Robles-Zurita,

McMeekin,

Sullivan

et al. 2024

Current Oncology

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Background: Diagnostic blood tests have the potential to identify lung cancer in people at high risk. We assessed the cost-effectiveness of a lung cancer screening intervention, using the EarlyCDT®-Lung Test (ECLS) with subsequent X-ray and low-dose chest CT scans (LDCT) for patients with a positive test result, compared to both usual care and LDCT screening for the target population. Methods: We conducted a model-based lifetime analysis from a UK NHS and personal social services perspective. We estimated incremental net monetary benefit (NMB) for the ECLS intervention compared to no screening and to LDCT screening. Results: The incremental NMB of ECLS intervention compared to no screening was GBP 33,179 (95% CI: −GBP 81,396, GBP 147,180) and GBP 140,609 (95% CI: −GBP 36,255, GBP 316,612), respectively, for a cost-effectiveness threshold of GBP 20,000 and GBP 30,000 per quality-adjusted life year. The same figures compared with LDCT screening were GBP 162,095 (95% CI: GBP 52,698, GBP 271,735) and GBP 52,185 (95% CI: −GBP 115,152, GBP 219,711). Conclusions: The ECLS intervention is the most cost-effective screening alternative, with the highest probability of being cost-effective, when compared to no screening or LDCT screening. This result may change with modifications of the parameters, suggesting that the three alternatives considered in the main analysis are potentially cost-effective.

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“…6 Evidence-informed approaches to integrating smoking cessation and reducing smoking-related inequalities are a major research priority for informing LCS practice and policy. 7 Various approaches have been tested including low-intensity interventions such as leaflets 8 and self-/practitioner-referral to external services. 9 Immediate provision of smoking cessation advice 10 and higher-intensity interventions such as offering multiple behavioural support sessions and/or pharmacotherapy [10][11][12] have shown promise in supporting cessation within LCS.…”

Section: Introductionmentioning

confidence: 99%

The importance of co-located, high intensity smoking cessation support within lung cancer screening: Findings from the Process Evaluation of the Yorkshire Enhanced Stop Smoking study

McCutchan,

Quinn-Scoggins,

Tong

et al. 2024

Preprint

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ObjectiveProcess evaluation of the Yorkshire Enhanced Stop Smoking (YESS) study intervention, to provide evidence regarding optimal integration of smoking cessation support within lung cancer screening (LCS).DesignMixed-methods process evaluation.SettingYESS was a Randomised Controlled Trial testing the effect of personalised smoking cessation support, integrated within LCS. YESS study participants were recruited from the Yorkshire Lung Screening Trial.Participants/data collectionSemi-structured interviews with 45 trial participants and eight SCPs 4, 12 and 52-weeks after screening (participants) or training (SCPs). Thematic analysis to assess intervention exposure, context, contamination and theory. Observations of SCP consultations on the screening unit (n=84; 4%) and 4-weeks after screening (n=132; 13%) tested intervention fidelity.InterventionThe YESS study tested opt-out, co-located standard best practice (SBP) smoking cessation support (control) versus a theory-informed personalised risk information booklet designed to increase efficacy beliefs in addition to SBP (booklet intervention), delivered by trained smoking cessation practitioners (SCPs).ResultsIntervention context was paramount: participants in both trial arms described benefits of co-located and ongoing high-intensity smoking cessation support, with immediate provision of pharmacotherapy. Tailored, non-judgemental care was considered key to initiating and sustaining quitting, particularly for participants at various points along their quit or those awaiting their scan result. Fidelity was high (98%) and moderate (75%) for SBP, moderate (77%) for the booklet intervention. Exposure varied by participants’ needs, including their screening results. Potential contamination was observed, with SCPs delivering elements of the booklet intervention training across both trial arms.ConclusionsA personalised approach is critical to supporting smoking cessation in LCS. Harnessing the benefits of LCS for supporting cessation at the time of screening requires investment in specialist practitioners to deliver person-centred smoking cessation support.Trial registration.www.clinicaltrials.gov/study/NCT03750110Putting research into contextWhat is already known on the topicIntegrated smoking cessation in lung cancer screening is recommended due to the additive benefits of screening participation and cessation on lung cancer mortality.Existing evidence supports the provision of higher-intensity smoking cessation interventions within lung cancer screening, such as immediate smoking cessation support at screening, with multiple sessions of behavioural counselling and/or pharmacotherapy.However, there is currently no consensus about the optimal high-intensity model to support smoking cessation using behavioural science principles within lung cancer screening. This is a major priority for research, practice and policy.What this study addsWe provide evidence for the benefits of co-located and longer-term (up to 12-weeks in person and remote) person-centred support, delivered by trained specialist lung screening SCPs, regardless of trial allocation.Future implementation of smoking cessation embedded in lung screening may benefit from investment in specialist lung screening SCPs, adopting a flexible, person-centred approach to the offer and delivery of SBP smoking cessation support.

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Defining the road map to a UK national lung cancer screening programme

Cited by 22 publications

References 76 publications

Incidence, prevalence, and survival of lung cancer in the United Kingdom from 2000-2021: a population-based cohort study

Incidence, prevalence, and survival of lung cancer in the United Kingdom from 2000-2021: a population-based cohort study

Health Economic Evaluation of Lung Cancer Screening Using a Diagnostic Blood Test: The Early Detection of Cancer of the Lung Scotland (ECLS)

The importance of co-located, high intensity smoking cessation support within lung cancer screening: Findings from the Process Evaluation of the Yorkshire Enhanced Stop Smoking study

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