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Usher-Smith JA, Godoy A, Kitt J, Farquhar F, Waller J, Sharp SJ, Shinkins B, Cartledge J, Kimuli M, Burge SW, Burbidge S, Eckert C, Hancock N, Marshall C, Rogerson S, Rossi SH, Smith A, Simmonds I, Wallace T, Ward M, Callister MEJ, Stewart GD. Short-term psychosocial outcomes of adding a non-contrast abdominal computed tomography (CT) scan to the thoracic CT within lung cancer screening. BJU Int 2024; 133:539-547. [PMID: 38097529 DOI: 10.1111/bju.16260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
OBJECTIVES To evaluate psychological, social, and financial outcomes amongst individuals undergoing a non-contrast abdominal computed tomography (CT) scan to screen for kidney cancer and other abdominal malignancies alongside the thoracic CT within lung cancer screening. SUBJECTS AND METHODS The Yorkshire Kidney Screening Trial (YKST) is a feasibility study of adding a non-contrast abdominal CT scan to the thoracic CT within lung cancer screening. A total of 500 participants within the YKST, comprising all who had an abnormal CT scan and a random sample of one-third of those with a normal scan between 14/03/2022 and 24/08/2022 were sent a questionnaire at 3 and 6 months. Outcomes included the Psychological Consequences Questionnaire (PCQ), the short-form of the Spielberger State-Trait Anxiety Inventory, and the EuroQoL five Dimensions five Levels scale (EQ-5D-5L). Data were analysed using regression adjusting for participant age, sex, socioeconomic status, education, baseline quality of life (EQ-5D-5L), and ethnicity. RESULTS A total of 380 (76%) participants returned questionnaires at 3 months and 328 (66%) at 6 months. There was no difference in any outcomes between participants with a normal scan and those with abnormal scans requiring no further action. Individuals requiring initial further investigations or referral had higher scores on the negative PCQ than those with normal scans at 3 months (standardised mean difference 0.28 sd, 95% confidence interval 0.01-0.54; P = 0.044). The difference was greater in those with anxiety or depression at baseline. No differences were seen at 6 months. CONCLUSION Screening for kidney cancer and other abdominal malignancies using abdominal CT alongside the thoracic CT within lung cancer screening is unlikely to cause significant lasting psychosocial or financial harm to participants with incidental findings.
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Affiliation(s)
- Juliet A Usher-Smith
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Angela Godoy
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Jessica Kitt
- Department of Surgery, University of Cambridge, Cambridge, UK
| | | | - Jo Waller
- Faculty of Life Sciences and Medicine, Kings College London, London, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Bethany Shinkins
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Sarah W Burge
- Department of Oncology, University of Cambridge, Cambridge, UK
| | | | - Claire Eckert
- Leeds Institute of Health Science, University of Leeds, Leeds, UK
| | - Neil Hancock
- Leeds Institute of Health Science, University of Leeds, Leeds, UK
| | | | | | - Sabrina H Rossi
- Department of Surgery, University of Cambridge, Cambridge, UK
| | | | - Irene Simmonds
- Leeds Institute of Health Science, University of Leeds, Leeds, UK
| | - Tom Wallace
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Matthew Ward
- Leeds Institute of Health Science, University of Leeds, Leeds, UK
| | - Matthew E J Callister
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Health Science, University of Leeds, Leeds, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
- CRUK Cambridge Centre, Cambridge, UK
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2
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Murray RL, Alexandris P, Baldwin D, Brain K, Britton J, Crosbie PAJ, Gabe R, Lewis S, Parrott S, Quaife SL, Tam HZ, Wu Q, Beeken R, Copeland H, Eckert C, Hancock N, Lindop J, McCutchan G, Marshall C, Neal RD, Rogerson S, Quinn Scoggins HD, Simmonds I, Thorley R, Callister ME. Uptake and 4-week quit rates from an opt-out co-located smoking cessation service delivered alongside community-based low-dose computed tomography screening within the Yorkshire Lung Screening Trial. Eur Respir J 2024; 63:2301768. [PMID: 38636970 PMCID: PMC11024392 DOI: 10.1183/13993003.01768-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/01/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Up to 50% of those attending for low-dose computed tomography screening for lung cancer continue to smoke and co-delivery of smoking cessation services alongside screening may maximise clinical benefit. Here we present data from an opt-out co-located smoking cessation service delivered alongside the Yorkshire Lung Screening Trial (YLST). METHODS Eligible YLST participants were offered an immediate consultation with a smoking cessation practitioner (SCP) at their screening visit with ongoing smoking cessation support over subsequent weeks. RESULTS Of 2150 eligible participants, 1905 (89%) accepted the offer of an SCP consultation during their initial visit, with 1609 (75%) receiving ongoing smoking cessation support over subsequent weeks. Uptake of ongoing support was not associated with age, ethnicity, deprivation or educational level in multivariable analyses, although men were less likely to engage (adjusted OR (ORadj) 0.71, 95% CI 0.56-0.89). Uptake was higher in those with higher nicotine dependency, motivation to stop smoking and self-efficacy for quitting. Overall, 323 participants self-reported quitting at 4 weeks (15.0% of the eligible population); 266 were validated by exhaled carbon monoxide (12.4%). Multivariable analyses of eligible smokers suggested 4-week quitting was more likely in men (ORadj 1.43, 95% CI 1.11-1.84), those with higher motivation to quit and previous quit attempts, while those with a stronger smoking habit in terms of cigarettes per day were less likely to quit. CONCLUSIONS There was high uptake for co-located opt-out smoking cessation support across a wide range of participant demographics. Protected funding for integrated smoking cessation services should be considered to maximise programme equity and benefit.
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Affiliation(s)
| | - Panos Alexandris
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - David Baldwin
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kate Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - John Britton
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Philip A J Crosbie
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Rhian Gabe
- Barts Clinical Trials Unit, Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Sarah Lewis
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Steve Parrott
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Samantha L Quaife
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Hui Zhen Tam
- Barts Clinical Trials Unit, Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Qi Wu
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Rebecca Beeken
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Harriet Copeland
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Claire Eckert
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Neil Hancock
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Grace McCutchan
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | | | - Richard D Neal
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Harriet D Quinn Scoggins
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Irene Simmonds
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Rebecca Thorley
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Matthew E Callister
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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3
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Illemann NM, Illemann TM. Mobile imaging trailers: A scoping review of CT and MRI modalities. Radiography (Lond) 2024; 30:431-439. [PMID: 38199159 DOI: 10.1016/j.radi.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/21/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Mobile Imaging Trailers enable moving diagnostic imaging equipment between locations requiring very little setup and configuration, example given CT-scanners and MRI-scanners. However, despite the apparent benefits of utilising these imaging capabilities, very little research on the subject exists. This study aims at gaining an overview of the current state of the literature, using the scoping review methodology. METHODS The systematic literature search was conducted in three databases: Scopus, Embase and PubMed. Included sources were extracted based on the objectives of the scoping review, and inspired by the by PRISMA-ScR. RESULTS 29 papers were included. CONCLUSION The results of the review showed that three general categories of research on this subject exist - trailers used in research, trailers as the object of research and trailers as an element or tool of the research. Of these, the most prevalent one used is the latter - trailers used as an element or tool of the research. This; however, is an issue for the use of trailers in a clinical setting, as very little research has been conducted on how they might be used and how they compare to fixed installations. As seen during the recent COVID-19 pandemic, the potentials for the use of MITs are immense; however, with the current lack of knowledge and understanding, the full potential has not been realised, suggesting further research should be focused in this area. IMPLICATIONS FOR PRACTICE This study has shown that the limited research in the area does point towards a few benefits of MITs; however, there is a clear lack of sufficient research on the field to say this with confidence.
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Affiliation(s)
- N M Illemann
- University College of Northern Denmark, Selma Lagerløfts vej 2, 9220 Aalborg East, Denmark.
| | - T M Illemann
- Department of the Built Environment, Aalborg University, Thomas Manns Vej 23, 9220 Aalborg East, Denmark
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Scobie H, Robb KA, Macdonald S, Harrow S, Sullivan F. Optimising recruitment to a lung cancer screening trial: A comparison of general practitioner and community-based recruitment. J Med Screen 2024; 31:46-52. [PMID: 37525582 PMCID: PMC10878003 DOI: 10.1177/09691413231190785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/07/2023] [Accepted: 07/11/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVES Pre-trial focus groups of the Early detection of Cancer of the Lung Scotland (ECLS) trial indicated that those at high risk of lung cancer are more likely to engage with community-based recruitment methods. The current study aimed to understand if general practitioner (GP) and community-based recruitment might attract different groups of people, and to quantitatively explore the demographic and psychosocial differences between people responding to GP or community-based recruitment. DESIGN Secondary data analysis of ECLS trial baseline data. METHODS Adults (n = 11,164) aged 50 to 75 years completed a baseline questionnaire as part of their participation in the ECLS trial. The questionnaire assessed smoking behaviour, health state, health anxiety and illness perception. Alongside demographic characteristics, how participants were made aware of the study/participant recruitment method (GP recruitment/community recruitment) was also obtained via trial records. RESULTS The likelihood of being recruited via community-based methods increased as deprivation level decreased. Those recruited via the community had higher levels of perceived personal control of developing lung cancer and were more likely to understand their own risk of developing lung cancer, compared to those who were recruited to the trial via their GP. Health state and health anxiety did not predict recruitment methods in multivariable analysis. CONCLUSIONS Community and opportunistic screening invitations were associated with uptake in people from less-deprived backgrounds, and therefore might not be the optimal method to reach those at high risk of lung cancer and living in more deprived areas.
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Affiliation(s)
- Hannah Scobie
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kathryn A Robb
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sara Macdonald
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stephen Harrow
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Frank Sullivan
- School of Medicine, University of St Andrews, St Andrews, Fife, UK
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Gooseman MR, Tentzeris V, Bulliment KL, Qadri SSA, Callister MEJ, Milton R, Chaudhuri N, Tcherveniakov P, Papagiannopoulos K, Cowen ME, Brunelli A. Impact of lung cancer screening on surgical stage distribution and surgical practice: a regional analysis of patients operated in and out of a screening program. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivad193. [PMID: 38001026 PMCID: PMC10899811 DOI: 10.1093/icvts/ivad193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/22/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVES The aim of this study was to assess variations in surgical stage distribution in 2 centres within the same UK region. One centre was covered by an active screening program started in November 2018 and the other was not covered by screening. METHODS Retrospective analysis of 1895 patients undergoing lung resections (2018-2022) in 2 centres. Temporal distribution was tested using Chi-squared for trends. A lowess curve was used to plot the proportion of stage 1A patients amongst those operated over the years. RESULTS The surgical populations in the 2 centres were similar. In the screening unit (SU), we observed a 18% increase in the proportion of patients with clinical stage IA in the recent phase compared to the early phase (59% vs 50%, P = 0.004), whilst this increase was not seen in the unit without screening. This difference was attributable to an increase of cT1aN0 patients in the SU (16% vs 11%, P = 0.035) which was not observed in the other unit (10% vs 8.2%, P = 0.41). In the SU, there was also a three-fold increase in the proportion of sublobar resections performed in the recent phase compared to the early one (35% vs 12%, P < 0.001). This finding was not evident in the unit without screening. CONCLUSIONS Lung cancer screening is associated with a higher proportion of lung cancers being detected at an earlier stage with a consequent increased practice of sublobar resections.
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Affiliation(s)
- Michael R Gooseman
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull University Teaching Hospitals, Cottingham, UK
| | - Vasileios Tentzeris
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull University Teaching Hospitals, Cottingham, UK
| | - Kerry L Bulliment
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull University Teaching Hospitals, Cottingham, UK
| | - Syed S A Qadri
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull University Teaching Hospitals, Cottingham, UK
| | - Matthew E J Callister
- Department of Respiratory Medicine, St James's University Hospital, Leeds Teaching Hospitals, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
| | - Richard Milton
- Department of Thoracic Surgery, St. James's University Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - Nilanjan Chaudhuri
- Department of Thoracic Surgery, St. James's University Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - Peter Tcherveniakov
- Department of Thoracic Surgery, St. James's University Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - Kostas Papagiannopoulos
- Department of Thoracic Surgery, St. James's University Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - Michael E Cowen
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull University Teaching Hospitals, Cottingham, UK
| | - Alessandro Brunelli
- School of Medicine, University of Leeds, Leeds, UK
- Department of Thoracic Surgery, St. James's University Hospital, Leeds Teaching Hospitals, Leeds, UK
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6
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Iball GR, Beeching CE, Gabe R, Tam HZ, Darby M, Crosbie PAJ, Callister MEJ. An evaluation of CT radiation doses within the Yorkshire Lung Screening Trial. Br J Radiol 2024; 97:469-476. [PMID: 38308037 DOI: 10.1093/bjr/tqad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/05/2023] [Accepted: 11/28/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES To evaluate radiation doses for all low-dose CT scans performed during the first year of a lung screening trial. METHODS For all lung screening scans that were performed using a CT protocol that delivered image quality meeting the RSNA QIBA criteria, radiation dose metrics, participant height, weight, gender, and age were recorded. Values of volume CT dose index (CTDIvol) and dose length product (DLP) were evaluated as a function of weight in order to assess the performance of the scan protocol across the participant cohort. Calculated effective doses were used to establish the additional lifetime attributable cancer risks arising from trial scans. RESULTS Median values of CTDIvol, DLP, and effective dose (IQR) from the 3521 scans were 1.1 mGy (0.70), 42.4 mGycm (24.9), and 1.15 mSv (0.67), whilst for 60-80kg participants the values were 1.0 mGy (0.30), 35.8 mGycm (11.4), and 0.97 mSv (0.31). A statistically significant correlation between CTDIvol and weight was identified for males (r = 0.9123, P < .001) and females (r = 0.9052, P < .001), however, the effect of gender on CTDIvol was not statistically significant (P = .2328) despite notable differences existing at the extremes of the weight range. The additional lifetime attributable cancer risks from a single scan were in the range 0.001%-0.006%. CONCLUSIONS Low radiation doses can be achieved across a typical lung screening cohort using scan protocols that have been shown to deliver high levels of image quality. The observed dose levels may be considered as typical values for lung screening scans on similar types of scanners for an equivalent participant cohort. ADVANCES IN KNOWLEDGE Presentation of typical radiation dose levels for CT lung screening examinations in a large UK trial. Effective radiation doses can be of the order of 1 mSv for standard sized participants. Lifetime attributable cancer risks resulting from a single low-dose CT scan did not exceed 0.006%.
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Affiliation(s)
- Gareth R Iball
- Faculty of Health Studies, University of Bradford, Richmond Road, Bradford, BD7 1DP, United Kingdom
- Department of Medical Physics & Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, LS1 3EX, United Kingdom
| | - Charlotte E Beeching
- Department of Medical Physics & Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, LS1 3EX, United Kingdom
| | - Rhian Gabe
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, EC1M 6BQ, United Kingdom
| | - Hui Zhen Tam
- Barts Clinical Trials Unit, Wolfson Institute of Population Health, Queen Mary University of London, EC1M 6BQ, United Kingdom
| | - Michael Darby
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, United Kingdom
| | - Philip A J Crosbie
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, M13 9NT, United Kingdom
| | - Matthew E J Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, United Kingdom
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7
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Pan X, Dvortsin E, Baldwin DR, Groen HJM, Ramaker D, Ryan J, Berge HT, Velikanova R, Oudkerk M, Postma MJ. Cost-effectiveness of volume computed tomography in lung cancer screening: a cohort simulation based on Nelson study outcomes. J Med Econ 2024; 27:27-38. [PMID: 38050691 DOI: 10.1080/13696998.2023.2288739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/24/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVES This study aimed to evaluate the cost-effectiveness of lung cancer screening (LCS) with volume-based low-dose computed tomography (CT) versus no screening for an asymptomatic high-risk population in the United Kingdom (UK), utilising the long-term insights provided by the NELSON study, the largest European randomized control trial investigating LCS. METHODS A cost-effectiveness analysis was conducted using a decision tree and a state-transition Markov model to simulate the identification, diagnosis, and treatments for a lung cancer high-risk population, from a UK National Health Service (NHS) perspective. Eligible participants underwent annual volume CT screening and were compared to a cohort without the option of screening. Screen-detected lung cancers, costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) were predicted. RESULTS Annual volume CT screening of 1.3 million eligible participants resulted in 96,474 more lung cancer cases detected in early stage, and 73,825 fewer cases in late stage, leading to 53,732 premature lung cancer deaths averted and 421,647 QALYs gained, compared to no screening. The ICER was £5,455 per QALY. These estimates were robust in sensitivity analyses. LIMITATIONS Lack of long-term survival data for lung cancer patients; deficiency in rigorous micro-costing studies to establish detailed treatment costs inputs for lung cancer patients. CONCLUSIONS Annual LCS with volume-based low-dose CT for a high-risk asymptomatic population is cost-effective in the UK, at a threshold of £20,000 per QALY, representing an efficient use of NHS resources with substantially improved outcomes for lung cancer patients, as well as additional societal and economic benefits for society as a whole. These findings advocate evidence-based decisions for the potential implementation of a nationwide LCS in the UK.
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Affiliation(s)
- Xuanqi Pan
- Institute for Diagnostic Accuracy, Groningen, The Netherlands
- Unit of Global Health, University of Groningen, Groningen, The Netherlands
| | - Evgeni Dvortsin
- Institute for Diagnostic Accuracy, Groningen, The Netherlands
| | - David R Baldwin
- Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Harry J M Groen
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dianne Ramaker
- Institute for Diagnostic Accuracy, Groningen, The Netherlands
| | - James Ryan
- Health Economics and Payer Evidence, AstraZeneca PLC, Cambridge, United Kingdom
| | - Hilde Ten Berge
- Institute for Diagnostic Accuracy, Groningen, The Netherlands
| | - Rimma Velikanova
- Unit of Global Health, University of Groningen, Groningen, The Netherlands
- Health Economics and Outcome Research, Asc Academics B.V, Groningen, The Netherlands
| | - Matthijs Oudkerk
- Institute for Diagnostic Accuracy, Groningen, The Netherlands
- Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
| | - Maarten J Postma
- Unit of Global Health, University of Groningen, Groningen, The Netherlands
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Goodley P, Balata H, Alonso A, Brockelsby C, Conroy M, Cooper-Moss N, Craig C, Evison M, Hewitt K, Higgins C, Johnson W, Lyons J, Merchant Z, Rowlands A, Sharman A, Sinnott N, Sperrin M, Booton R, Crosbie PAJ. Invitation strategies and participation in a community-based lung cancer screening programme located in areas of high socioeconomic deprivation. Thorax 2023; 79:58-67. [PMID: 37586744 PMCID: PMC10803959 DOI: 10.1136/thorax-2023-220001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 07/19/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Although lung cancer screening is being implemented in the UK, there is uncertainty about the optimal invitation strategy. Here, we report participation in a community screening programme following a population-based invitation approach, examine factors associated with participation, and compare outcomes with hypothetical targeted invitations. METHODS Letters were sent to all individuals (age 55-80) registered with a general practice (n=35 practices) in North and East Manchester, inviting ever-smokers to attend a Lung Health Check (LHC). Attendees at higher risk (PLCOm2012NoRace score≥1.5%) were offered two rounds of annual low-dose CT screening. Primary care recorded smoking codes (live and historical) were used to model hypothetical targeted invitation approaches for comparison. RESULTS Letters were sent to 35 899 individuals, 71% from the most socioeconomically deprived quintile. Estimated response rate in ever-smokers was 49%; a lower response rate was associated with younger age, male sex, and primary care recorded current smoking status (adjOR 0.55 (95% CI 0.52 to 0.58), p<0.001). 83% of eligible respondents attended an LHC (n=8887/10 708). 51% were eligible for screening (n=4540/8887) of whom 98% had a baseline scan (n=4468/4540). Screening adherence was 83% (n=3488/4199) and lung cancer detection 3.2% (n=144) over 2 rounds. Modelled targeted approaches required 32%-48% fewer invitations, identified 94.6%-99.3% individuals eligible for screening, and included 97.1%-98.6% of screen-detected lung cancers. DISCUSSION Using a population-based invitation strategy, in an area of high socioeconomic deprivation, is effective and may increase screening accessibility. Due to limitations in primary care records, targeted approaches should incorporate historical smoking codes and individuals with absent smoking records.
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Affiliation(s)
- Patrick Goodley
- Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester, Manchester, UK
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Haval Balata
- Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester, Manchester, UK
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Alberto Alonso
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Christopher Brockelsby
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Matthew Conroy
- Manchester Integrated Care Partnership (NHS Greater Manchester), Manchester, UK
| | | | - Christopher Craig
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Matthew Evison
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Kath Hewitt
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Coral Higgins
- Manchester Integrated Care Partnership (NHS Greater Manchester), Manchester, UK
| | - William Johnson
- Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Judith Lyons
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Zoe Merchant
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Ailsa Rowlands
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Anna Sharman
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Nicola Sinnott
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Matthew Sperrin
- Division of Informatics Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Richard Booton
- Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester, Manchester, UK
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Philip A J Crosbie
- Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester, Manchester, UK
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
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9
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Field JK. Road map to improve the quality of lung cancer risk data. Thorax 2023; 79:11-12. [PMID: 37879904 DOI: 10.1136/thorax-2023-220784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/27/2023]
Affiliation(s)
- John K Field
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
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10
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Smith P, Quinn-Scoggins H, Murray RL, McCutchan G, Nelson A, Moore G, Callister M, Tong H, Brain K. Barriers and facilitators to engaging in smoking cessation support among lung screening participants. Nicotine Tob Res 2023:ntad245. [PMID: 38071660 DOI: 10.1093/ntr/ntad245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Embedded smoking cessation support within lung cancer screening is recommended in the UK; however, little is known about why individuals decline smoking cessation support in this setting. This study identified psychosocial factors that influence smoking cessation and quit motivation among those who declined support for quitting smoking alongside lung cancer screening. METHODS Qualitative interviews conducted between August 2019 - April 2021 with thirty adults with a smoking history, recruited from the Yorkshire Lung Screening Trial. Participants had declined smoking cessation support. Verbatim interview transcripts were thematically analysed. RESULTS Fifty percent of participants were male and the majority were from the most deprived groups. Participants reported low motivation and a variety of barriers to stopping smoking. Participants described modifiable behavioural factors that influenced their quit motivation including self-efficacy, perceived effectiveness of stop-smoking services including smoking cessation aids, risk-minimising beliefs, lack of social support, absence of positive influences on smoking and beliefs about smoking/smoking cessation. Broader contextual factors included social isolation and stigma, COVID-19 and comorbid mental and physical health conditions that deterred smoking cessation. CONCLUSIONS To encourage engagement in smoking cessation support during lung cancer screening, interventions should seek to encourage positive beliefs about the effectiveness of smoking cessation aids and increase confidence in quitting as part of supportive, person-centred care. Interventions should also acknowledge the wider social determinants of health among the lung screening-eligible population. IMPLICATIONS This study provides an in-depth understanding of the beliefs surrounding smoking and smoking cessation and further potential psychosocial factors that influence those attending lung cancer screening. Many of the barriers to smoking cessation found in the present study are similar to those outside of a lung screening setting however this work offers an understanding of potential facilitators that should be considered in future lung screening programmes.
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Affiliation(s)
- Pamela Smith
- Cardiff University, Division of Population Medicine, Heath Park, Cardiff, UK
| | | | - Rachael L Murray
- University of Nottingham, Division of Epidemiology and Public Health Clinical Sciences, Nottingham City Hospital
| | - Grace McCutchan
- Cardiff University, Division of Population Medicine, Heath Park, Cardiff, UK
| | - Annmarie Nelson
- Cardiff University, Marie Curie Research Centre, Cardiff, UK
| | - Graham Moore
- Cardiff University, School of Social Sciences, 1-3 Museum Place, Cardiff, UK
| | - Mat Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Hoang Tong
- Cardiff University, Division of Population Medicine, Heath Park, Cardiff, UK
| | - Kate Brain
- Cardiff University, Division of Population Medicine, Heath Park, Cardiff, UK
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11
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Susai CJ, Velotta JB, Sakoda LC. Clinical Adjuncts to Lung Cancer Screening: A Narrative Review. Thorac Surg Clin 2023; 33:421-432. [PMID: 37806744 PMCID: PMC10926946 DOI: 10.1016/j.thorsurg.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
The updated US Preventive Services Task Force guidelines on lung cancer screening have significantly expanded the population of screening eligible adults, among whom the balance of benefits and harms associated with lung cancer screening vary considerably. Clinical adjuncts are additional information and tools that can guide decision-making to optimally screen individuals who are most likely to benefit. Proposed adjuncts include integration of clinical history, risk prediction models, shared-decision-making tools, and biomarker tests at key steps in the screening process. Although evidence regarding their clinical utility and implementation is still evolving, they carry significant promise in optimizing screening effectiveness and efficiency for lung cancer.
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Affiliation(s)
- Cynthia J Susai
- UCSF East Bay General Surgery, 1411 East 31st Street QIC 22134, Oakland, CA 94612, USA
| | - Jeffrey B Velotta
- Department of Thoracic Surgery, Kaiser Permanente Northern California, 3600 Broadway, Oakland, CA 94611, USA
| | - Lori C Sakoda
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
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12
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Upperton SEC, Bradley C, Bhartia BSK, Crosbie PAJ, Darby M, Gabe R, Hammond C, Hancock N, Marshall C, Kennedy MPT, Callister M. The radiology quality assurance process in the Yorkshire Lung Screening Trial, and findings from the baseline round of low dose CT screening for lung cancer. Br J Radiol 2023; 96:20230126. [PMID: 37656217 PMCID: PMC10607416 DOI: 10.1259/bjr.20230126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/25/2023] [Accepted: 06/13/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVE As lung cancer screening is rolled-out, there is a need to develop an effective quality assurance (QA) framework around radiology reporting to ensure optimal implementation. Here, we report a structured QA process for low-dose CT (LDCT) scans performed in the Yorkshire Lung Screening Trial. METHODS Negative LDCT scans were single read after using computer-aided detection software. The radiology QA process included reviewing 5% of negative scans selected at random, and all cases with a subsequent diagnosis of extrapulmonary cancer or interval lung cancer not detected on the baseline scan. Radiologists were not informed of the reason for review and original radiology reports were scored as either "satisfactory", "satisfactory with learning points", or "unsatisfactory". RESULTS From 6650 participants undergoing LDCT screening, 208 negative scans were reviewed alongside 11 cases with subsequent extrapulmonary cancer and 10 cases with interval lung cancer. Overall, only three reports were ultimately judged "unsatisfactory", 1% of randomly selected negative scans (n = 2/208) and one interval lung cancer scan (n = 1/10). Four out of a total of five cases judged "satisfactory with learning points" were related to oesophageal abnormalities where the participant was subsequently diagnosed with oesophageal cancer. CONCLUSION The described process attempts to minimise bias in retrospective review of screening scans, and may represent a framework for future QA of national screening programmes. ADVANCES IN KNOWLEDGE This study describes a structured QA process for a lung cancer screening programme, involving blinded second-read of LDCT screening scans to ensure fair, constructive audit of clinical performance.
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Affiliation(s)
- Sara E C Upperton
- Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Claire Bradley
- Department of Respiratory Medicine, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Bobby S K Bhartia
- Department of Radiology, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Philip A J Crosbie
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
| | - Michael Darby
- Department of Radiology, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Rhian Gabe
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | | | - Neil Hancock
- Leeds Diagnosis and Screening Unit, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Catriona Marshall
- Leeds Diagnosis and Screening Unit, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Martyn P T Kennedy
- Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Matthew Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, United Kingdom
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13
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Campi R, Rebez G, Klatte T, Roussel E, Ouizad I, Ingels A, Pavan N, Kara O, Erdem S, Bertolo R, Capitanio U, Mir MC. Effect of smoking, hypertension and lifestyle factors on kidney cancer - perspectives for prevention and screening programmes. Nat Rev Urol 2023; 20:669-681. [PMID: 37328546 DOI: 10.1038/s41585-023-00781-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/18/2023]
Abstract
Renal cell carcinoma (RCC) incidence has doubled over the past few decades. However, death rates have remained stable as the number of incidental renal mass diagnoses peaked. RCC has been recognized as a European health care issue, but to date, no screening programmes have been introduced. Well-known modifiable risk factors for RCC are smoking, obesity and hypertension. A direct association between cigarette consumption and increased RCC incidence and RCC-related death has been reported, but the underlying mechanistic pathways for this association are still unclear. Obesity is associated with an increased risk of RCC, but interestingly, improved survival outcomes have been reported in obese patients, a phenomenon known as the obesity paradox. Data on the association between other modifiable risk factors such as diet, dyslipidaemia and physical activity with RCC incidence are conflicting, and potential mechanisms underlying these associations remain to be elucidated.
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Affiliation(s)
- Riccardo Campi
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
- Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, Netherlands
| | - Giacomo Rebez
- Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, Netherlands
- Department of Urology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Tobias Klatte
- Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, Netherlands
- Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK
| | - Eduard Roussel
- Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, Netherlands
- Department of Urology, KU Leuven, Leuven, Belgium
| | - Idir Ouizad
- Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, Netherlands
- Department of Urology, Bichat-Claude Bernard Hospital, Paris, France
| | - Alexander Ingels
- Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, Netherlands
- Department of Urology, Henri Mondor Hospital, Créteil, France
| | - Nicola Pavan
- Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, Netherlands
- Department of Urology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Onder Kara
- Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, Netherlands
- Faculty of Medicine, Kocaeli University, İzmit, Turkey
| | - Selcuk Erdem
- Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, Netherlands
- Department of Urology, Istanbul University, Istanbul, Turkey
| | - Riccardo Bertolo
- Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, Netherlands
- Urology Unit, Department of Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Umberto Capitanio
- Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, Netherlands
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Maria Carmen Mir
- Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, Netherlands.
- Department of Urology, Hospital Universitario La Ribera, Valencia, Spain.
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14
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O'Dowd EL, Tietzova I, Bartlett E, Devaraj A, Biederer J, Brambilla M, Brunelli A, Chorostowska J, Decaluwe H, Deruysscher D, De Wever W, Donoghue M, Fabre A, Gaga M, van Geffen W, Hardavella G, Kauczor HU, Kerpel-Fronius A, van Meerbeeck J, Nagavci B, Nestle U, Novoa N, Prosch H, Prokop M, Putora PM, Rawlinson J, Revel MP, Snoeckx A, Veronesi G, Vliegenthart R, Weckbach S, Blum TG, Baldwin DR. ERS/ESTS/ESTRO/ESR/ESTI/EFOMP statement on management of incidental findings from low dose CT screening for lung cancer. Eur J Cardiothorac Surg 2023; 64:ezad302. [PMID: 37804174 PMCID: PMC10876118 DOI: 10.1093/ejcts/ezad302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/06/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Screening for lung cancer with low radiation dose computed tomography has a strong evidence base, is being introduced in several European countries and is recommended as a new targeted cancer screening programme. The imperative now is to ensure that implementation follows an evidence-based process that will ensure clinical and cost effectiveness. This European Respiratory Society (ERS) task force was formed to provide an expert consensus for the management of incidental findings which can be adapted and followed during implementation. METHODS A multi-European society collaborative group was convened. 23 topics were identified, primarily from an ERS statement on lung cancer screening, and a systematic review of the literature was conducted according to ERS standards. Initial review of abstracts was completed and full text was provided to members of the group for each topic. Sections were edited and the final document approved by all members and the ERS Science Council. RESULTS Nine topics considered most important and frequent were reviewed as standalone topics (interstitial lung abnormalities, emphysema, bronchiectasis, consolidation, coronary calcification, aortic valve disease, mediastinal mass, mediastinal lymph nodes and thyroid abnormalities). Other topics considered of lower importance or infrequent were grouped into generic categories, suitable for general statements. CONCLUSIONS This European collaborative group has produced an incidental findings statement that can be followed during lung cancer screening. It will ensure that an evidence-based approach is used for reporting and managing incidental findings, which will mean that harms are minimised and any programme is as cost-effective as possible.
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Affiliation(s)
- Emma L O'Dowd
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Ilona Tietzova
- Charles University, First Faculty of Medicine, Department of Tuberculosis and Respiratory Diseases, Prague, Czech Republic
| | - Emily Bartlett
- Royal Brompton and Harefield NHS Foundation Trust, Radiology, London, UK
| | - Anand Devaraj
- Royal Brompton and Harefield NHS Foundation Trust, Radiology, London, UK
| | - Jürgen Biederer
- University of Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Germany
- German Center for Lung Research DZL, Translational Lung Research Center TLRC, Heidelberg, Germany
- University of Latvia, Faculty of Medicine, Riga, Latvia
- Christian-Albrechts-Universität zu Kiel, Faculty of Medicine, Kiel, Germany
| | - Marco Brambilla
- Azienda Ospedaliero-Universitaria Maggiore della Carità di Novara, Novara, Italy
| | | | - Joanna Chorostowska
- Institute of Tuberculosis and Lung Diseases, Warsaw, Genetics and Clinical Immunology, Warsaw, Poland
| | | | - Dirk Deruysscher
- Maastricht University Medical Centre, Department of Radiation Oncology (MAASTRO Clinic), GROW-School for Oncology and Developmental Biology, Limburg, The Netherlands
| | - Walter De Wever
- Universitaire Ziekenhuizen Leuven, Radiology, Leuven, Belgium
| | | | - Aurelie Fabre
- University College Dublin School of Medicine, Histopathology, Dublin, Ireland
| | - Mina Gaga
- Sotiria General Hospital of Chest Diseases of Athens, 7th Respiratory Medicine Department, Athens, Greece
| | - Wouter van Geffen
- Medical Centre Leeuwarden, Department of Respiratory Medicine, Leeuwarden, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
| | - Georgia Hardavella
- Sotiria General Hospital of Chest Diseases of Athens, Respiratory Medicine, Athens, Greece
| | - Hans-Ulrich Kauczor
- University of Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Germany
- German Center for Lung Research DZL, Translational Lung Research Center TLRC, Heidelberg, Germany
| | - Anna Kerpel-Fronius
- National Koranyi Institute of Pulmonology, Department of Radiology, Budapest, Hungary
| | | | - Blin Nagavci
- Institute for Evidence in Medicine, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Ursula Nestle
- Kliniken Maria Hilf GmbH Monchengladbach, Nordrhein-Westfalen, Germany
| | - Nuria Novoa
- University Hospital of Salamanca, Thoracic Surgery, Salamanca, Spain
| | - Helmut Prosch
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Vienna, Austria
| | - Mathias Prokop
- Radboud University Nijmegen Medical Center, Department of Radiology, Nijmegen, The Netherlands
| | - Paul Martin Putora
- Kantonsspital Sankt Gallen, Radiation Oncology, Sankt Gallen, Switzerland
- Inselspital Universitatsspital Bern, Radiation Oncology, Bern, Switzerland
| | | | - Marie-Pierre Revel
- Cochin Hospital, APHP, Radiology Department, Paris, France
- Université de Paris, Paris, France
| | | | - Giulia Veronesi
- Humanitas Research Hospital, Division of Thoracic and General Surgery, Rozzano, Italy
| | | | - Sabine Weckbach
- UniversitatsKlinikum Heidelberg, Heidelberg, Germany
- Bayer AG, Research and Development, Pharmaceuticals, Radiology, Berlin, Germany
| | - Torsten G Blum
- HELIOS Klinikum Emil von Behring GmbH, Lungenklinik Heckeshorn, Berlin, Germany
| | - David R Baldwin
- University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Department of Respiratory Medicine, Nottingham, UK
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15
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O'Dowd EL, Tietzova I, Bartlett E, Devaraj A, Biederer J, Brambilla M, Brunelli A, Chorostowska-Wynimko J, Decaluwe H, Deruysscher D, De Wever W, Donoghue M, Fabre A, Gaga M, van Geffen W, Hardavella G, Kauczor HU, Kerpel-Fronius A, van Meerbeeck J, Nagavci B, Nestle U, Novoa N, Prosch H, Prokop M, Putora PM, Rawlinson J, Revel MP, Snoeckx A, Veronesi G, Vliegenthart R, Weckbach S, Blum TG, Baldwin DR. ERS/ESTS/ESTRO/ESR/ESTI/EFOMP statement on management of incidental findings from low dose CT screening for lung cancer. Eur Respir J 2023; 62:2300533. [PMID: 37802631 DOI: 10.1183/13993003.00533-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/06/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Screening for lung cancer with low radiation dose computed tomography has a strong evidence base, is being introduced in several European countries and is recommended as a new targeted cancer screening programme. The imperative now is to ensure that implementation follows an evidence-based process that will ensure clinical and cost effectiveness. This European Respiratory Society (ERS) task force was formed to provide an expert consensus for the management of incidental findings which can be adapted and followed during implementation. METHODS A multi-European society collaborative group was convened. 23 topics were identified, primarily from an ERS statement on lung cancer screening, and a systematic review of the literature was conducted according to ERS standards. Initial review of abstracts was completed and full text was provided to members of the group for each topic. Sections were edited and the final document approved by all members and the ERS Science Council. RESULTS Nine topics considered most important and frequent were reviewed as standalone topics (interstitial lung abnormalities, emphysema, bronchiectasis, consolidation, coronary calcification, aortic valve disease, mediastinal mass, mediastinal lymph nodes and thyroid abnormalities). Other topics considered of lower importance or infrequent were grouped into generic categories, suitable for general statements. CONCLUSIONS This European collaborative group has produced an incidental findings statement that can be followed during lung cancer screening. It will ensure that an evidence-based approach is used for reporting and managing incidental findings, which will mean that harms are minimised and any programme is as cost-effective as possible.
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Affiliation(s)
- Emma L O'Dowd
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Ilona Tietzova
- Charles University, First Faculty of Medicine, Department of Tuberculosis and Respiratory Diseases, Prague, Czech Republic
| | - Emily Bartlett
- Royal Brompton and Harefield NHS Foundation Trust, Radiology, London, UK
| | - Anand Devaraj
- Royal Brompton and Harefield NHS Foundation Trust, Radiology, London, UK
| | - Jürgen Biederer
- University of Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Germany
- German Center for Lung Research DZL, Translational Lung Research Center TLRC, Heidelberg, Germany
- University of Latvia, Faculty of Medicine, Riga, Latvia
- Christian-Albrechts-Universität zu Kiel, Faculty of Medicine, Kiel, Germany
| | - Marco Brambilla
- Azienda Ospedaliero-Universitaria Maggiore della Carità di Novara, Novara, Italy
| | | | | | | | - Dirk Deruysscher
- Maastricht University Medical Centre, Department of Radiation Oncology (MAASTRO Clinic), GROW-School for Oncology and Developmental Biology, Limburg, The Netherlands
| | - Walter De Wever
- Universitaire Ziekenhuizen Leuven, Radiology, Leuven, Belgium
| | | | - Aurelie Fabre
- University College Dublin School of Medicine, Histopathology, Dublin, Ireland
| | - Mina Gaga
- Sotiria General Hospital of Chest Diseases of Athens, 7th Respiratory Medicine Department, Athens, Greece
| | - Wouter van Geffen
- Medical Centre Leeuwarden, Department of Respiratory Medicine, Leeuwarden, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
| | - Georgia Hardavella
- Sotiria General Hospital of Chest Diseases of Athens, Respiratory Medicine, Athens, Greece
| | - Hans-Ulrich Kauczor
- University of Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Germany
- German Center for Lung Research DZL, Translational Lung Research Center TLRC, Heidelberg, Germany
| | - Anna Kerpel-Fronius
- National Koranyi Institute of Pulmonology, Department of Radiology, Budapest, Hungary
| | | | - Blin Nagavci
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Ursula Nestle
- Kliniken Maria Hilf GmbH Monchengladbach, Nordrhein-Westfalen, Germany
| | - Nuria Novoa
- University Hospital of Salamanca, Thoracic Surgery, Salamanca, Spain
| | - Helmut Prosch
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Vienna, Austria
| | - Mathias Prokop
- Radboud University Nijmegen Medical Center, Department of Radiology, Nijmegen, The Netherlands
| | - Paul Martin Putora
- Kantonsspital Sankt Gallen, Radiation Oncology, Sankt Gallen, Switzerland
- Inselspital Universitatsspital Bern, Radiation Oncology, Bern, Switzerland
| | | | - Marie-Pierre Revel
- Cochin Hospital, APHP, Radiology Department, Paris, France
- Université de Paris, Paris, France
| | | | - Giulia Veronesi
- Humanitas Research Hospital, Division of Thoracic and General Surgery, Rozzano, Italy
| | | | - Sabine Weckbach
- UniversitatsKlinikum Heidelberg, Heidelberg, Germany
- Bayer AG, Research and Development, Pharmaceuticals, Radiology, Berlin, Germany
| | - Torsten G Blum
- HELIOS Klinikum Emil von Behring GmbH, Lungenklinik Heckeshorn, Berlin, Germany
| | - David R Baldwin
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, UK
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16
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Catto JW, North B, Goff M, Carter A, Sleeth M, Mandrik O, Chilcott J, Sasieni P, Cumberbatch MGK. Protocol for the YORKSURe prospective multistage study testing the feasibility for early detection of bladder cancer in populations with high disease-specific mortality risk. BMJ Open 2023; 13:e076612. [PMID: 37678944 PMCID: PMC10496676 DOI: 10.1136/bmjopen-2023-076612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023] Open
Abstract
INTRODUCTION Around 25% of patients with bladder cancer (BCa) present with invasive disease. Non-randomised studies of population-based screening have suggested reductions in BCa-specific mortality are possible through earlier detection. The low prevalence of lethal disease in the general population means screening is not cost-effective and there is no consensus on the best strategy. Yorkshire has some of the highest mortality rates from BCa in England. We aim to test whether population screening in a region of high mortality risk will lead to a downward stage-migration of aggressive BCa, improved survival and is cost-effective. METHODS AND ANALYSIS YORKSURe is a tiered, randomised, multicohort study to test the feasibility of a large BCa screening randomised controlled trial. In three parallel cohorts, participants will self-test urine (at home) up to six times. Results are submitted via a mobile app or freephone. Those with a positive result will be invited for further investigation at community-based early detection clinics or within usual National Health Service (NHS) pathways. In Cohort 1, we will post self-testing kits to research engaged participants (n=2000) embedded within the Yorkshire Lung Screening Trial. In Cohort 2, we will post self-testing kits to 3000 invitees. Cohort 2 participants will be randomised between haematuria and glycosuria testing using a reveal/conceal design. In Cohort 3, we will post self-testing kits to 500 patients within the NHS pathway for investigation of haematuria. Our primary outcomes are rates of recruitment and randomisation, rates of positive test and acceptability of the design. The study is currently recruiting and scheduled to finish in June 2023. ETHICS AND DISSEMINATION The study has received the following approvals: London Riverside Research Ethics Committee (22/LO/0018) and Health Research Authority Confidentiality Advisory Group (20/CAG/0009). Results will be made available to providers and researchers via publicly accessible scientific journals. TRIAL REGISTRATION NUMBER ISRCTN34273159.
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Affiliation(s)
- James Wf Catto
- Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
- Division of Clinical Medicine, University of Sheffield, Sheffield, UK
| | - Bernard North
- Cancer Prevention Trials Unit, King's College London, London, UK
| | - Megan Goff
- Cancer Prevention Trials Unit, King's College London, London, UK
| | - Abigail Carter
- Cancer Prevention Trials Unit, King's College London, London, UK
| | - Michelle Sleeth
- Cancer Prevention Trials Unit, King's College London, London, UK
| | - Olena Mandrik
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Jim Chilcott
- Health Economics and Decision Science, University of Sheffield, Sheffield, UK
| | - Peter Sasieni
- Cancer Prevention Trials Unit, King's College London, London, UK
| | - Marcus G K Cumberbatch
- Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
- Division of Clinical Medicine, University of Sheffield, Sheffield, UK
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17
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Upperton S, Beirne P, Bhartia B, Boland A, Bradley C, Crosbie PAJ, Darby M, Eckert C, Gabe R, Hancock N, Kennedy MPT, Lindop J, Rogerson S, Shinkins B, Simmonds I, Sutherland TJT, Callister MEJ. Diagnoses and treatments for participants with interstitial lung abnormalities detected in the Yorkshire Lung Screening Trial. BMJ Open Respir Res 2023; 10:e001490. [PMID: 37612098 PMCID: PMC10450038 DOI: 10.1136/bmjresp-2022-001490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 07/31/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION Interstitial lung abnormalities (ILA) are relatively common incidental findings in participants undergoing low-dose CT screening for lung cancer. Some ILA are transient and inconsequential, but others represent interstitial lung disease (ILD). Lung cancer screening therefore offers the opportunity of earlier diagnosis and treatment of ILD for some screening participants. METHODS The prevalence of ILA in participants in the baseline screening round of the Yorkshire Lung Screening Trial is reported, along with the proportion referred to a regional ILD service, eventual diagnoses, outcomes and treatments. RESULTS Of 6650 participants undergoing screening, ILA were reported in 169 (2.5%) participants. Following review in a screening review meeting, 56 participants were referred to the ILD service for further evaluation (0.8% of all screening participants). 2 participants declined referral, 1 is currently awaiting review and the remaining 53 were confirmed as having ILD. Eventual diagnoses were idiopathic pulmonary fibrosis (n=14), respiratory bronchiolitis ILD (n=4), chronic hypersensitivity pneumonitis (n=2), connective tissue disease/rheumatoid arthritis-related ILD (n=4), asbestosis (n=1), idiopathic non-specific interstitial pneumonia (n=1), sarcoidosis (n=1) and pleuroparenchymal fibroelastosis (n=1). Twenty five patients had unclassifiable idiopathic interstitial pneumonia. Overall, 10 people received pharmacotherapy (7 antifibrotics and 3 prednisolone) representing 18% of those referred to the ILD service and 0.15% of those undergoing screening. 32 people remain under surveillance in the ILD service, some of whom may require treatment in future. DISCUSSION Lung cancer screening detects clinically significant cases of ILD allowing early commencement of disease-modifying treatment in a proportion of participants. This is the largest screening cohort to report eventual diagnoses and treatments and provides an estimate of the level of clinical activity to be expected by ILD services as lung cancer screening is implemented. Further research is needed to clarify the optimal management of screen-detected ILD. TRIAL REGISTRATION NUMBER ISRCTN42704678.
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Affiliation(s)
- Sara Upperton
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Beirne
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Bobby Bhartia
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Alison Boland
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Claire Bradley
- Craigavon Area Hospital, Southern Health and Social Care Trust, Portadown, UK
| | - Philip A J Crosbie
- Division of Infection, Immunity & Respiratory Medicine, The University of Manchester, Manchester, UK
| | - Mike Darby
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Claire Eckert
- Leeds Diagnosis and Screening Unit, University of Leeds, Leeds, UK
| | - Rhian Gabe
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Neil Hancock
- Leeds Diagnosis and Screening Unit, University of Leeds, Leeds, UK
| | - Martyn P T Kennedy
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jason Lindop
- Department of Research and Innovation, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Suzanne Rogerson
- Department of Research and Innovation, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Bethany Shinkins
- Leeds Diagnosis and Screening Unit, University of Leeds, Leeds, UK
| | - Irene Simmonds
- Leeds Diagnosis and Screening Unit, University of Leeds, Leeds, UK
| | - Tim J T Sutherland
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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18
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Bradley C, Alexandris P, Baldwin DR, Booton R, Darby M, Eckert CJ, Gabe R, Hancock N, Janes S, Kennedy M, Lindop J, Neal RD, Rogerson S, Shinkins B, Simmonds I, Upperton S, Vestbo J, Crosbie PA, Callister ME. Measuring spirometry in a lung cancer screening cohort highlights possible underdiagnosis and misdiagnosis of COPD. ERJ Open Res 2023; 9:00203-2023. [PMID: 37609601 PMCID: PMC10440649 DOI: 10.1183/23120541.00203-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/09/2023] [Indexed: 08/24/2023] Open
Abstract
Introduction COPD is underdiagnosed, and measurement of spirometry alongside low-dose computed tomography (LDCT) screening for lung cancer is one strategy to increase earlier diagnosis of this disease. Methods Ever-smokers at high risk of lung cancer were invited to the Yorkshire Lung Screening Trial for a lung health check (LHC) comprising LDCT screening, pre-bronchodilator spirometry and a smoking cessation service. In this cross-sectional study we present data on participant demographics, respiratory symptoms, lung function, emphysema on imaging and both self-reported and primary care diagnoses of COPD. Multivariable logistic regression analysis identified factors associated with possible underdiagnosis and misdiagnosis of COPD in this population, with airflow obstruction defined as forced expiratory volume in 1 s/forced vital capacity ratio <0.70. Results Out of 3920 LHC attendees undergoing spirometry, 17% had undiagnosed airflow obstruction with respiratory symptoms, representing potentially undiagnosed COPD. Compared to those with a primary care COPD code, this population had milder symptoms, better lung function and were more likely to be current smokers (p≤0.001 for all comparisons). Out of 836 attendees with a primary care COPD code who underwent spirometry, 19% did not have airflow obstruction, potentially representing misdiagnosed COPD, although symptom burden was high. Discussion Spirometry offered alongside LDCT screening can potentially identify cases of undiagnosed and misdiagnosed COPD. Future research should assess the downstream impact of these findings to determine whether any meaningful changes to treatment and outcomes occur, and to assess the impact on co-delivering spirometry on other parameters of LDCT screening performance such as participation and adherence. Additionally, work is needed to better understand the aetiology of respiratory symptoms in those with misdiagnosed COPD, to ensure that this highly symptomatic group receive evidence-based interventions.
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Affiliation(s)
- Claire Bradley
- Department Respiratory Medicine, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Panos Alexandris
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - David R. Baldwin
- Department of Respiratory Medicine, City Campus, Nottingham University Hospitals, Nottingham, UK
| | - Richard Booton
- Lung Cancer and Thoracic Surgery Directorate, Heart and Lung Division, Manchester University NHS Foundation Trust, Manchester, UK
| | - Mike Darby
- Department of Radiology, Leeds Teaching Hospitals, Leeds, UK
| | - Claire J. Eckert
- Leeds Diagnosis and Screening Unit, Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Rhian Gabe
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Neil Hancock
- Leeds Diagnosis and Screening Unit, Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sam Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Martyn Kennedy
- Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, UK
| | - Jason Lindop
- Department of Research and Innovation, Leeds Teaching Hospitals, Leeds, UK
| | - Richard D. Neal
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Suzanne Rogerson
- Department of Research and Innovation, Leeds Teaching Hospitals, Leeds, UK
| | - Bethany Shinkins
- Leeds Diagnosis and Screening Unit, Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Irene Simmonds
- Leeds Diagnosis and Screening Unit, Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sara Upperton
- Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, UK
| | - Jorgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
| | - Philip A.J. Crosbie
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
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19
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Tisi S, Creamer AW, Dickson J, Horst C, Quaife S, Hall H, Verghese P, Gyertson K, Bowyer V, Levermore C, Hacker AM, Teague J, Farrelly L, Nair A, Devaraj A, Hackshaw A, Hurst JR, Janes S. Prevalence and clinical characteristics of non-malignant CT detected incidental findings in the SUMMIT lung cancer screening cohort. BMJ Open Respir Res 2023; 10:e001664. [PMID: 37321665 PMCID: PMC10277548 DOI: 10.1136/bmjresp-2023-001664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Pulmonary and extrapulmonary incidental findings are frequently identified on CT scans performed for lung cancer screening. Uncertainty regarding their clinical significance and how and when such findings should be reported back to clinicians and participants persists. We examined the prevalence of non-malignant incidental findings within a lung cancer screening cohort and investigated the morbidity and relevant risk factors associated with incidental findings. We quantified the primary and secondary care referrals generated by our protocol. METHODS The SUMMIT study (NCT03934866) is a prospective observational cohort study to examine the performance of delivering a low-dose CT (LDCT) screening service to a high-risk population. Spirometry, blood pressure, height/weight and respiratory history were assessed as part of a Lung Health Check. Individuals at high risk of lung cancer were offered an LDCT and returned for two further annual visits. This analysis is a prospective evaluation of the standardised reporting and management protocol for incidental findings developed for the study on the baseline LDCT. RESULTS In 11 115 participants included in this analysis, the most common incidental findings were coronary artery calcification (64.2%) and emphysema (33.4%). From our protocolised management approach, the number of participants requiring review for clinically relevant findings in primary care was 1 in 20, and the number potentially requiring review in secondary care was 1 in 25. CONCLUSIONS Incidental findings are common in lung cancer screening and can be associated with reported symptoms and comorbidities. A standardised reporting protocol allows systematic assessment and standardises onward management.
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Affiliation(s)
- Sophie Tisi
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Andrew W Creamer
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Jennifer Dickson
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Carolyn Horst
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Samantha Quaife
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Helen Hall
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Priyam Verghese
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Kylie Gyertson
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Vicky Bowyer
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Claire Levermore
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Anne-Marie Hacker
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Jonathon Teague
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Laura Farrelly
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Arjun Nair
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Anand Devaraj
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield NHS Trust, London, UK
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Samuel Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
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20
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Harrison H, Wood A, Pennells L, Rossi SH, Callister M, Cartledge J, Stewart GD, Usher-Smith JA. Estimating the Effectiveness of Kidney Cancer Screening Within Lung Cancer Screening Programmes: A Validation in UK Biobank. Eur Urol Oncol 2023; 6:351-353. [PMID: 37003861 DOI: 10.1016/j.euo.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/07/2023] [Accepted: 02/23/2023] [Indexed: 04/03/2023]
Abstract
In the absence of population-based screening, addition of screening for kidney cancer to lung cancer screening could provide an efficient and low-resource means to improve early detection. In this study, we used the UK Biobank cohort (n = 442 865) to determine the performance of the Yorkshire Lung Cancer Screening Trial (YLST) eligibility criteria for selecting individuals for kidney cancer screening. We measured the performance of two models widely used to determine eligibility for lung cancer screening (PLCO[m2012] and the Liverpool-Lung-Project-v2) and the performance of the combined YLST criteria. We found that the lung cancer models have discrimination (area under the receiver operating curve) between 0.60 and 0.68 for kidney cancer. In the UK, one in four cases (25%) of kidney cancer cases is expected to occur in those eligible for lung cancer screening, and one case of kidney cancer detected for every 200 people invited to lung cancer screening. These results suggest that adding kidney cancer screening to lung cancer screening would be an effective strategy to improve early detection rates of kidney cancer. However, most kidney cancers would not be picked up by this approach. This analysis does not address other important considerations about kidney cancer screening, such as overdiagnosis. PATIENT SUMMARY: It has been proposed that adding-on kidney cancer screening to lung cancer screening (both carried out by a computed tomography scan of the chest/abdomen) would be an easy and low-cost way of detecting cases of kidney cancer earlier, when these can be treated more easily. Lung cancer screening is usually targeted at people who are at a high risk (eg, older smokers); therefore, here we look at whether the same group of people are also at a high risk of kidney cancer. Our analysis shows that one in four people later diagnosed with kidney cancer are also at a high risk of lung cancer; hence, a combined screening programme could detect up to a quarter of kidney cancers.
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Affiliation(s)
- Hannah Harrison
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - Angela Wood
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Lisa Pennells
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sabrina H Rossi
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Matthew Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Jon Cartledge
- St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Juliet A Usher-Smith
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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21
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O'Dowd EL, Lee RW, Akram AR, Bartlett EC, Bradley SH, Brain K, Callister MEJ, Chen Y, Devaraj A, Eccles SR, Field JK, Fox J, Grundy S, Janes SM, Ledson M, MacKean M, Mackie A, McManus KG, Murray RL, Nair A, Quaife SL, Rintoul R, Stevenson A, Summers Y, Wilkinson LS, Booton R, Baldwin DR, Crosbie P. Defining the road map to a UK national lung cancer screening programme. Lancet Oncol 2023; 24:e207-e218. [PMID: 37142382 DOI: 10.1016/s1470-2045(23)00104-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 05/06/2023]
Abstract
Lung cancer screening with low-dose CT was recommended by the UK National Screening Committee (UKNSC) in September, 2022, on the basis of data from trials showing a reduction in lung cancer mortality. These trials provide sufficient evidence to show clinical efficacy, but further work is needed to prove deliverability in preparation for a national roll-out of the first major targeted screening programme. The UK has been world leading in addressing logistical issues with lung cancer screening through clinical trials, implementation pilots, and the National Health Service (NHS) England Targeted Lung Health Check Programme. In this Policy Review, we describe the consensus reached by a multiprofessional group of experts in lung cancer screening on the key requirements and priorities for effective implementation of a programme. We summarise the output from a round-table meeting of clinicians, behavioural scientists, stakeholder organisations, and representatives from NHS England, the UKNSC, and the four UK nations. This Policy Review will be an important tool in the ongoing expansion and evolution of an already successful programme, and provides a summary of UK expert opinion for consideration by those organising and delivering lung cancer screenings in other countries.
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Affiliation(s)
- Emma L O'Dowd
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Richard W Lee
- Early Diagnosis and Detection Centre, National Institute for Health and Care Research Biomedical Research Centre at the Royal Marsden and Institute of Cancer Research, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
| | - Ahsan R Akram
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK; Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Emily C Bartlett
- Royal Brompton and Harefield Hospitals London and National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Kate Brain
- Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | | | - Yan Chen
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Anand Devaraj
- Royal Brompton and Harefield Hospitals London and National Heart and Lung Institute, Imperial College London, London, UK
| | - Sinan R Eccles
- Royal Glamorgan Hospital, Cwm Taf Morgannwg University Health Board, Llantrisant, UK
| | - John K Field
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Jesme Fox
- Roy Castle Lung Cancer Foundation, Liverpool, UK
| | - Seamus Grundy
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Sam M Janes
- Lungs for Living Research Centre, Department of Respiratory Medicine, University College London, London, UK
| | - Martin Ledson
- Department of Respiratory Medicine, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | | | - Kieran G McManus
- Department of Thoracic Surgery, Royal Victoria Hospital, Belfast, UK
| | - Rachael L Murray
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Arjun Nair
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Samantha L Quaife
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Robert Rintoul
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Anne Stevenson
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Yvonne Summers
- The Christie Hospital NHS Trust, Manchester University NHS Foundation Trust, Manchester, UK
| | - Louise S Wilkinson
- Oxford Breast Imaging Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Booton
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Philip Crosbie
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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22
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Crosbie PAJ, Callister MEJ. Optimising eligibility criteria for lung cancer screening. THE LANCET RESPIRATORY MEDICINE 2023:S2213-2600(23)00083-8. [PMID: 37030306 DOI: 10.1016/s2213-2600(23)00083-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 04/07/2023]
Affiliation(s)
- Philip A J Crosbie
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK
| | - Matthew E J Callister
- Department of Respiratory Medicine, St James's University Hospital, Leeds Teaching Hospitals, Leeds LS9 7TF, UK.
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23
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Bradley C, Boland A, Clarke L, Dallinson N, Eckert C, Ellames D, Finn J, Gabe R, Hancock N, Kennedy MP, Lindop J, Mohamed A, Mullen G, Murray RL, Rogerson S, Shinkins B, Simmonds I, Upperton S, Wilkinson A, Crosbie PA, Callister ME. Diagnosis and treatment outcomes from prebronchodilator spirometry performed alongside lung cancer screening in a Lung Health Check programme. Thorax 2023; 78:543-550. [PMID: 36972979 DOI: 10.1136/thorax-2022-219683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/02/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Incorporating spirometry into low-dose CT (LDCT) screening for lung cancer may help identify people with undiagnosed chronic obstructive pulmonary disease (COPD), although the downstream impacts are not well described. METHODS Participants attending a Lung Health Check (LHC) as part of the Yorkshire Lung Screening Trial were offered spirometry alongside LDCT screening. Results were communicated to the general practitioner (GP), and those with unexplained symptomatic airflow obstruction (AO) fulfilling agreed criteria were referred to the Leeds Community Respiratory Team (CRT) for assessment and treatment. Primary care records were reviewed to determine changes to diagnostic coding and pharmacotherapy. RESULTS Of 2391 LHC participants undergoing prebronchodilator spirometry, 201 (8.4%) fulfilled the CRT referral criteria of which 151 were invited for further assessment. Ninety seven participants were subsequently reviewed by the CRT, 46 declined assessment and 8 had already been seen by their GP at the time of CRT contact. Overall 70 participants had postbronchodilator spirometry checked, of whom 20 (29%) did not have AO. Considering the whole cohort referred to the CRT (but excluding those without AO postbronchodilation), 59 had a new GP COPD code, 56 commenced new pharmacotherapy and 5 were underwent pulmonary rehabilitation (comprising 2.5%, 2.3% and 0.2% of the 2391 participants undergoing LHC spirometry). CONCLUSIONS Delivering spirometry alongside lung cancer screening may facilitate earlier diagnosis of COPD. However, this study highlights the importance of confirming AO by postbronchodilator spirometry prior to diagnosing and treating patients with COPD and illustrates some downstream challenges in acting on spirometry collected during an LHC.
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Affiliation(s)
- Claire Bradley
- Department of Respiratory Medicine, Belfast Health and Social Care Trust, Belfast, UK
| | - Alison Boland
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Louisa Clarke
- Community Respiratory Team, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Naomi Dallinson
- Community Respiratory Team, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Claire Eckert
- Leeds Diagnosis and Screening Unit, Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Deborah Ellames
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jonathan Finn
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rhian Gabe
- Barts Clinical Trials Unit, Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Neil Hancock
- Leeds Diagnosis and Screening Unit, Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Martyn Pt Kennedy
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jason Lindop
- Department of Research and Innovation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ayad Mohamed
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gabriel Mullen
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rachael L Murray
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Suzanne Rogerson
- Department of Research and Innovation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Bethany Shinkins
- Leeds Diagnosis and Screening Unit, Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Irene Simmonds
- Leeds Diagnosis and Screening Unit, Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sara Upperton
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Anne Wilkinson
- Community Respiratory Team, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Philip A Crosbie
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Matthew Ej Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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24
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Quinn-Scoggins HD, Murray RL, Quaife SL, Smith P, Brain KE, Callister MEJ, Baldwin DR, Britton J, Crosbie PAJ, Thorley R, McCutchan GM. Co-development of an evidence-based personalised smoking cessation intervention for use in a lung cancer screening context. BMC Pulm Med 2022; 22:478. [PMID: 36522781 PMCID: PMC9756588 DOI: 10.1186/s12890-022-02263-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Optimising smoking cessation services within a low radiation-dose computed tomography (LDCT) lung cancer screening programme has the potential to improve cost-effectiveness and overall efficacy of the programme. However, evidence on the optimal design and integration of cessation services is limited. We co-developed a personalised cessation and relapse prevention intervention incorporating medical imaging collected during lung cancer screening. The intervention is designed to initiate and support quit attempts among smokers attending screening as part of the Yorkshire Enhanced Stop Smoking study (YESS: ISRCTN63825779). Patients and public were involved in the development of an intervention designed to meet the needs of the target population. METHODS An iterative co-development approach was used. Eight members of the public with a history of smoking completed an online survey to inform the visual presentation of risk information in subsequent focus groups for acceptability testing. Three focus groups (n = 13) were conducted in deprived areas of Yorkshire and South Wales with members of the public who were current smokers or recent quitters (within the last year). Exemplar images of the heart and lungs acquired by LDCT, absolute and relative lung cancer risk, and lung age were shown. Data were analysed thematically, and discussed in stakeholder workshops. Draft versions of the intervention were developed, underpinned by the Extended Parallel Processing Model to increase self-efficacy and response-efficacy. The intervention was further refined in a second stakeholder workshop with a patient panel. RESULTS Individual LDCT scan images of the lungs and heart, in conjunction with artistic impressions to facilitate interpretation, were considered by public participants to be most impactful in prompting cessation. Public participants thought it important to have a trained practitioner guiding them through the intervention and emphasising the short-term benefits of quitting. Presentation of absolute and relative risk of lung cancer and lung age were considered highly demotivating due to reinforcement of fatalistic beliefs. CONCLUSION An acceptable personalised intervention booklet utilising LDCT scan images has been developed for delivery by a trained smoking cessation practitioner. Our findings highlight the benefit of co-development during intervention development and the need for further evaluation of effectiveness.
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Affiliation(s)
- Harriet D Quinn-Scoggins
- Division of Population Medicine, School of Medicine, Cardiff University, 8th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Rachael L Murray
- Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Samantha L Quaife
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Pamela Smith
- Division of Population Medicine, School of Medicine, Cardiff University, 8th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Kate E Brain
- Division of Population Medicine, School of Medicine, Cardiff University, 8th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Matthew E J Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - David R Baldwin
- Department of Respiratory Medicine, Nottingham University Hospital, Nottingham, UK
| | - John Britton
- Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Philip A J Crosbie
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rebecca Thorley
- Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Grace M McCutchan
- Division of Population Medicine, School of Medicine, Cardiff University, 8th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
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Cavers D, Nelson M, Rostron J, Robb KA, Brown LR, Campbell C, Akram AR, Dickie G, Mackean M, van Beek EJR, Sullivan F, Steele RJ, Neilson AR, Weller D. Optimizing the implementation of lung cancer screening in Scotland: Focus group participant perspectives in the LUNGSCOT study. Health Expect 2022; 25:3246-3258. [PMID: 36263948 PMCID: PMC9700133 DOI: 10.1111/hex.13632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/15/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Targeted lung cancer screening is effective in reducing lung cancer and all-cause mortality according to major trials in the United Kingdom and Europe. However, the best ways of implementing screening in local communities requires an understanding of the population the programme will serve. We undertook a study to explore the views of those potentially eligible for, and to identify potential barriers and facilitators to taking part in, lung screening, to inform the development of a feasibility study. METHODS Men and women aged 45-70, living in urban and rural Scotland, and either self-reported people who smoke or who recently quit, were invited to take part in the study via research agency Taylor McKenzie. Eleven men and 14 women took part in three virtual focus groups exploring their views on lung screening. Focus group transcripts were transcribed and analysed using thematic analysis, assisted by QSR NVivo. FINDINGS Three overarching themes were identified: (1) Knowledge, awareness and acceptability of lung screening, (2) Barriers and facilitators to screening and (3) Promoting screening and implementation ideas. Participants were largely supportive of lung screening in principle and described the importance of the early detection of cancer. Emotional and psychological concerns as well as system-level and practical issues were discussed as posing barriers and facilitators to lung screening. CONCLUSIONS Understanding the views of people potentially eligible for a lung health check can usefully inform the development of a further study to test the feasibility and acceptability of lung screening in Scotland. PATIENT OR PUBLIC CONTRIBUTION The LUNGSCOT study has convened a patient advisory group to advise on all aspects of study development and implementation. Patient representatives commented on the focus group study design, study materials and ethics application, and two representatives read the focus group transcripts.
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Affiliation(s)
- Debbie Cavers
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Mia Nelson
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Jasmin Rostron
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
- Present address:
The National Institute of Economic and Social Research2 Dean Trench Street, London NW1P 3HEUK
| | - Kathryn A. Robb
- School of Health and WellbeingUniversity of GlasgowGlasgowUK
| | | | - Christine Campbell
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Ahsan R. Akram
- Centre for Inflammation Research and Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Graeme Dickie
- Care of the Usher InstituteUniversity of Edinburgh, EdinburghEdinburghUK
| | | | - Edwin J. R. van Beek
- Edinburgh Imaging, Queen's Medical Research InstituteUniversity of EdinburghEdinburghUK
| | | | - Robert J. Steele
- School of Medicine, Ninewells HospitalUniversity of DundeeDundeeUK
| | - Aileen R. Neilson
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - David Weller
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
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Dickson JL, Hall H, Horst C, Tisi S, Verghese P, Worboys S, Perugia A, Rusius J, Mullin AM, Teague J, Farrelly L, Bowyer V, Gyertson K, Bojang F, Levermore C, Anastasiadis T, McCabe J, Devaraj A, Nair A, Navani N, Hackshaw A, Quaife SL, Janes SM. Utilisation of primary care electronic patient records for identification and targeted invitation of individuals to a lung cancer screening programme. Lung Cancer 2022; 173:94-100. [PMID: 36179541 PMCID: PMC10533413 DOI: 10.1016/j.lungcan.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/27/2022] [Accepted: 09/13/2022] [Indexed: 11/22/2022]
Abstract
Lung cancer screening (LCS) eligibility is largely determined by tobacco consumption. Primary care smoking data could guide LCS invitation and eligibility assessment. We present observational data from the SUMMIT Study, where individual self-reported smoking status was concordant with primary care records in 75.3%. However, 10.3% demonstrated inconsistencies between historic and most recent smoking status documentation. Quantified tobacco consumption was frequently missing, precluding direct LCS eligibility assessment. Primary care recorded "ever-smoker" status, encompassing both recent and historic documentation, can be used to target LCS invitation. Identifying those with missing or erroneous "never-smoker" smoking status is crucial for equitable invitation to LCS.
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Affiliation(s)
- Jennifer L Dickson
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Helen Hall
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Carolyn Horst
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Sophie Tisi
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Priyam Verghese
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | | | | | | | - Anne-Marie Mullin
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Jonathan Teague
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Laura Farrelly
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Vicky Bowyer
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Kylie Gyertson
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Fanta Bojang
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Claire Levermore
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - John McCabe
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Arjun Nair
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; University College London Hospitals NHS Foundation Trust, London, UK
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Samantha L Quaife
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; University College London Hospitals NHS Foundation Trust, London, UK.
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Crosbie PAJ, Gabe R, Simmonds I, Hancock N, Alexandris P, Kennedy M, Rogerson S, Baldwin D, Booton R, Bradley C, Darby M, Eckert C, Franks KN, Lindop J, Janes SM, Møller H, Murray RL, Neal RD, Quaife SL, Upperton S, Shinkins B, Tharmanathan P, Callister MEJ. Participation in community-based lung cancer screening: the Yorkshire Lung Screening Trial. Eur Respir J 2022; 60:2200483. [PMID: 35777775 PMCID: PMC9684623 DOI: 10.1183/13993003.00483-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/17/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Screening with low-dose computed tomography (LDCT) reduces lung cancer mortality; however, the most effective strategy for optimising participation is unknown. Here we present data from the Yorkshire Lung Screening Trial, including response to invitation, screening eligibility and uptake of community-based LDCT screening. METHODS Individuals aged 55-80 years, identified from primary care records as having ever smoked, were randomised prior to consent to invitation to telephone lung cancer risk assessment or usual care. The invitation strategy included general practitioner endorsement, pre-invitation and two reminder invitations. After telephone triage, those at higher risk were invited to a Lung Health Check (LHC) with immediate access to a mobile CT scanner. RESULTS Of 44 943 individuals invited, 50.8% (n=22 815) responded and underwent telephone-based risk assessment (16.7% and 7.3% following first and second reminders, respectively). A lower response rate was associated with current smoking status (adjusted OR 0.44, 95% CI 0.42-0.46) and socioeconomic deprivation (adjusted OR 0.58, 95% CI 0.54-0.62 for the most versus the least deprived quintile). Of those responding, 34.4% (n=7853) were potentially eligible for screening and offered a LHC, of whom 86.8% (n=6819) attended. Lower uptake was associated with current smoking status (adjusted OR 0.73, 95% CI 0.62-0.87) and socioeconomic deprivation (adjusted OR 0.78, 95% CI 0.62-0.98). In total, 6650 individuals had a baseline LDCT scan, representing 99.7% of eligible LHC attendees. CONCLUSIONS Telephone risk assessment followed by a community-based LHC is an effective strategy for lung cancer screening implementation. However, lower participation associated with current smoking status and socioeconomic deprivation underlines the importance of research to ensure equitable access to screening.
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Affiliation(s)
- Philip A J Crosbie
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
- These two authors contributed equally
| | - Rhian Gabe
- Centre for Cancer Prevention, Queen Mary University of London, London, UK
- These two authors contributed equally
| | - Irene Simmonds
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Neil Hancock
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Panos Alexandris
- Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | | | | | - David Baldwin
- Dept of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - Richard Booton
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Claire Bradley
- Craigavon Area Hospital, Southern Health and Social Care Trust, Portadown, UK
| | - Mike Darby
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Claire Eckert
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kevin N Franks
- Institute of Health Sciences, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Henrik Møller
- The Danish Clinical Quality Program and Clinical Registries (RKKP), Aarhus, Denmark
| | - Rachael L Murray
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Richard D Neal
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Samantha L Quaife
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | | | | | - Matthew E J Callister
- Institute of Health Sciences, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Dickson JL, Hall H, Horst C, Tisi S, Verghese P, Mullin AM, Teague J, Farrelly L, Bowyer V, Gyertson K, Bojang F, Levermore C, Anastasiadis T, Sennett K, McCabe J, Devaraj A, Nair A, Navani N, Callister ME, Hackshaw A, Quaife SL, Janes SM. Telephone risk-based eligibility assessment for low-dose CT lung cancer screening. Thorax 2022; 77:1036-1040. [PMID: 35863766 PMCID: PMC9510431 DOI: 10.1136/thoraxjnl-2021-218634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 06/09/2022] [Indexed: 12/17/2022]
Abstract
Eligibility for lung cancer screening (LCS) requires assessment of lung cancer risk, based on smoking history alongside demographic and medical factors. Reliance on individual face-to-face eligibility assessment risks inefficiency and costliness. The SUMMIT Study introduced a telephone-based lung cancer risk assessment to guide invitation to face-to-face LCS eligibility assessment, which significantly increased the proportion of face-to-face attendees eligible for LCS. However, levels of agreement between phone screener and in-person responses were lower in younger individuals and minority ethnic groups. Telephone-based risk assessment is an efficient way to optimise selection for LCS appointments but requires further iteration to ensure an equitable approach.
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Affiliation(s)
- Jennifer L Dickson
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Helen Hall
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Carolyn Horst
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Sophie Tisi
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Priyam Verghese
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Anne-Marie Mullin
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Jonathan Teague
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Laura Farrelly
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Vicky Bowyer
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Kylie Gyertson
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Fanta Bojang
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Claire Levermore
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - John McCabe
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Arjun Nair
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Matthew Ej Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, Yorkshire, UK
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Samantha L Quaife
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
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Usher-Smith JA, Godoy A, Burge SW, Burbidge S, Cartledge J, Crosbie PAJ, Eckert C, Farquhar F, Hammond D, Hancock N, Iball GR, Kimuli M, Masson G, Neal RD, Rogerson S, Rossi SH, Sala E, Smith A, Sharp SJ, Simmonds I, Wallace T, Ward M, Callister MEJ, Stewart GD. The Yorkshire Kidney Screening Trial (YKST): protocol for a feasibility study of adding non-contrast abdominal CT scanning to screen for kidney cancer and other abdominal pathology within a trial of community-based CT screening for lung cancer. BMJ Open 2022; 12:e063018. [PMID: 36127097 PMCID: PMC9490622 DOI: 10.1136/bmjopen-2022-063018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Kidney cancer (renal cell cancer (RCC)) is the seventh most common cancer in the UK. As RCC is largely curable if detected at an early stage and most patients have no symptoms, there is international interest in evaluating a screening programme for RCC. The Yorkshire Kidney Screening Trial (YKST) will assess the feasibility of adding non-contrast abdominal CT scanning to screen for RCC and other abdominal pathology within the Yorkshire Lung Screening Trial (YLST), a randomised trial of community-based CT screening for lung cancer. METHODS AND ANALYSIS In YLST, ever-smokers aged 55-80 years registered with a general practice in Leeds have been randomised to a Lung Health Check assessment, including a thoracic low-dose CT (LDCT) for those at high risk of lung cancer, or routine care. YLST participants randomised to the Lung Health Check arm who attend for the second round of screening at 2 years without a history of RCC or abdominal CT scan within the previous 6 months will be invited to take part in YKST. We anticipate inviting 4700 participants. Those who consent will have an abdominal CT immediately following their YLST thoracic LDCT. A subset of participants and the healthcare workers involved will be invited to take part in a qualitative interview. Primary objectives are to quantify the uptake of the abdominal CT, assess the acceptability of the combined screening approach and pilot the majority of procedures for a subsequent randomised controlled trial of RCC screening within lung cancer screening. ETHICS AND DISSEMINATION YKST was approved by the North West-Preston Research Ethics Committee (21/NW/0021), and the Health Research Authority on 3 February 2021. Trial results will be disseminated at clinical meetings, in peer-reviewed journals and to policy-makers. Findings will be made available to participants via the study website (www.YKST.org). TRIAL REGISTRATION NUMBERS NCT05005195 and ISRCTN18055040.
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Affiliation(s)
- Juliet A Usher-Smith
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Angela Godoy
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Sarah W Burge
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Simon Burbidge
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK, Leeds, UK
| | - Jon Cartledge
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK, Leeds, UK
| | - Philip A J Crosbie
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Claire Eckert
- Leeds Institiute of Health Sciences, University of Leeds, Leeds, UK
| | - Fiona Farquhar
- Research and Innovation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - David Hammond
- Research and Innovation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Neil Hancock
- Leeds Diagnosis & Screening Unit, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Gareth R Iball
- Department of Medical Physics & Engineering, Leeds teaching hospitals NHS Trust, Leeds, UK
| | - Michael Kimuli
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK, Leeds, UK
| | - Golnessa Masson
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Pitcairn Practice, Balmullo Surgery, Fife, UK
| | - Richard D Neal
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Suzanne Rogerson
- Research and Innovation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sabrina H Rossi
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Evis Sala
- Department of Radiology, University of Cambridge, Cambridge, UK
- Department of Radiology, Catholic University Sacro Cuore and Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Andrew Smith
- Upper Gastro-intestinal and Pancreas Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Irene Simmonds
- Leeds Institiute of Health Sciences, University of Leeds, Leeds, UK
| | - Tom Wallace
- Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Matthew Ward
- Leeds Institiute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
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Predicting the prevalence of lung cancer using feature transformation techniques. EGYPTIAN INFORMATICS JOURNAL 2022. [DOI: 10.1016/j.eij.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lung Cancer Screening: New Perspective and Challenges in Europe. Cancers (Basel) 2022; 14:cancers14092343. [PMID: 35565472 PMCID: PMC9099920 DOI: 10.3390/cancers14092343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/08/2022] [Accepted: 04/27/2022] [Indexed: 12/19/2022] Open
Abstract
Simple Summary Screening for lung cancer in a high-risk population has been shown to be beneficial, with reduced mortality in large randomised trials. However, the general implementation of screening is not evident and many factors have to be considered. In this paper, we will review the current status of screening for lung cancer in Europe and the many hurdles that have to be overcome. Multidisciplinary cooperation between all specialists dealing with lung cancer is required to obtain the best outcome. Hopefully, Europe’s Beating Cancer Plan will incorporate screening for lung cancer to allow general implementation by similar programmes in every European Member State. This will also provide an opportunity for further, large-scale studies to refine the inclusion of specific risk populations, diagnosis and management of screen-detected nodules. Abstract Randomized-controlled trials have shown clear evidence that lung cancer screening with low-dose CT in a high-risk population of current or former smokers can significantly reduce lung-cancer-specific mortality by an inversion of stage distribution at diagnosis. This paper will review areas in which there is good or emerging evidence and areas which still require investment, research or represent implementation challenges. The implementation of population-based lung cancer screening in Europe is variable and fragmented. A number of European countries seem be on the verge of implementing lung cancer screening, mainly through the implementation of studies or trials. The cost and capacity of CT scanners and radiologists are considered to be the main hurdles for future implementation. Actions by the European Commission, related to its published Europe’s Beating Cancer Plan and the proposal to update recommendations on cancer screening, could be an incentive to help speed up its implementation.
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Grover H, King W, Bhattarai N, Moloney E, Sharp L, Fuller L. Systematic review of the cost-effectiveness of screening for lung cancer with low dose computed tomography. Lung Cancer 2022; 170:20-33. [DOI: 10.1016/j.lungcan.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/23/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
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Huber RM, Cavic M, Kerpel-Fronius A, Viola L, Field J, Jiang L, Kazerooni EA, Koegelenberg CF, Mohan A, Sales dos Santos R, Ventura L, Wynes M, Yang D, Zulueta J, Lee CT, Tammemägi MC, Henschke CI, Lam S. Lung Cancer Screening Considerations During Respiratory Infection Outbreaks, Epidemics or Pandemics: An International Association for the Study of Lung Cancer Early Detection and Screening Committee Report. J Thorac Oncol 2022; 17:228-238. [PMID: 34864164 PMCID: PMC8639478 DOI: 10.1016/j.jtho.2021.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 02/02/2023]
Abstract
After the results of two large, randomized trials, the global implementation of lung cancer screening is of utmost importance. However, coronavirus disease 2019 infections occurring at heightened levels during the current global pandemic and also other respiratory infections can influence scan interpretation and screening safety and uptake. Several respiratory infections can lead to lesions that mimic malignant nodules and other imaging changes suggesting malignancy, leading to an increased level of follow-up procedures or even invasive diagnostic procedures. In periods of increased rates of respiratory infections from severe acute respiratory syndrome coronavirus 2 and others, there is also a risk of transmission of these infections to the health care providers, the screenees, and patients. This became evident with the severe acute respiratory syndrome coronavirus 2 pandemic that led to a temporary global stoppage of lung cancer and other cancer screening programs. Data on the optimal management of these situations are not available. The pandemic is still ongoing and further periods of increased respiratory infections will come, in which practical guidance would be helpful. The aims of this report were: (1) to summarize the data available for possible false-positive results owing to respiratory infections; (2) to evaluate the safety concerns for screening during times of increased respiratory infections, especially during a regional outbreak or an epidemic or pandemic event; (3) to provide guidance on these situations; and (4) to stimulate research and discussions about these scenarios.
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Affiliation(s)
- Rudolf M. Huber
- Division of Respiratory Medicine and Thoracic Oncology, Department of Medicine V, Ludwig-Maximilian-University of Munich, Thoracic Oncology Centre Munich, German Centre for Lung Research (DZL CPC-M), Munich, Germany,Corresponding author. Address for correspondence: Rudolf M. Huber, MD, PhD, Division of Respiratory Medicine and Thoracic Oncology, Department of Medicine V, Ludwig-Maximilians-University of Munich, Thoracic Oncology Centre Munich, German Centre for Lung Research (DZL CPC-M), Ziemssenstrasse 1, Munich, Bavaria D-80336 Germany
| | - Milena Cavic
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Anna Kerpel-Fronius
- Department of Radiology, National Korányi Institute for Pulmonology, Budapest, Hungary
| | - Lucia Viola
- Thoracic Oncology Unit, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - John Field
- Roy Castle Lung Cancer Research Programme, The University of Liverpool, Department of Molecular and Clinical Cancer Medicine, Liverpool, United Kingdom
| | - Long Jiang
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, People’s Republic of China
| | - Ella A. Kazerooni
- Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan Medical School/Michigan Medicine, Ann Arbor, Michigan,Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School/Michigan Medicine, Ann Arbor, Michigan
| | - Coenraad F.N. Koegelenberg
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Anant Mohan
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Luigi Ventura
- Thoracic Surgery, Department of Medicine and Surgery, University Hospital of Parma, Italy
| | - Murry Wynes
- The International Association for the Study of Lung Cancer, Denver, Colorado
| | - Dawei Yang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Javier Zulueta
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine, New York, New York
| | - Choon-Taek Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seoul, South Korea
| | - Martin C. Tammemägi
- Prevention and Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada,Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Claudia I. Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stephen Lam
- Department of Integrative Oncology, BC Cancer and Department of Medicine, University of British Columbia, Vancouver, Canada
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Tammemägi MC, Ruparel M, Tremblay A, Myers R, Mayo J, Yee J, Atkar-Khattra S, Yuan R, Cressman S, English J, Bedard E, MacEachern P, Burrowes P, Quaife SL, Marshall H, Yang I, Bowman R, Passmore L, McWilliams A, Brims F, Lim KP, Mo L, Melsom S, Saffar B, Teh M, Sheehan R, Kuok Y, Manser R, Irving L, Steinfort D, McCusker M, Pascoe D, Fogarty P, Stone E, Lam DCL, Ng MY, Vardhanabhuti V, Berg CD, Hung RJ, Janes SM, Fong K, Lam S. USPSTF2013 versus PLCOm2012 lung cancer screening eligibility criteria (International Lung Screening Trial): interim analysis of a prospective cohort study. Lancet Oncol 2022; 23:138-148. [PMID: 34902336 PMCID: PMC8716337 DOI: 10.1016/s1470-2045(21)00590-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Lung cancer is a major health problem. CT lung screening can reduce lung cancer mortality through early diagnosis by at least 20%. Screening high-risk individuals is most effective. Retrospective analyses suggest that identifying individuals for screening by accurate prediction models is more efficient than using categorical age-smoking criteria, such as the US Preventive Services Task Force (USPSTF) criteria. This study prospectively compared the effectiveness of the USPSTF2013 and PLCOm2012 model eligibility criteria. METHODS In this prospective cohort study, participants from the International Lung Screening Trial (ILST), aged 55-80 years, who were current or former smokers (ie, had ≥30 pack-years smoking history or ≤15 quit-years since last permanently quitting), and who met USPSTF2013 criteria or a PLCOm2012 risk threshold of at least 1·51% within 6 years of screening, were recruited from nine screening sites in Canada, Australia, Hong Kong, and the UK. After enrolment, patients were assessed with the USPSTF2013 criteria and the PLCOm2012 risk model with a threshold of at least 1·70% at 6 years. Data were collected locally and centralised. Main outcomes were the comparison of lung cancer detection rates and cumulative life expectancies in patients with lung cancer between USPSTF2013 criteria and the PLCOm2012 model. In this Article, we present data from an interim analysis. To estimate the incidence of lung cancers in individuals who were USPSTF2013-negative and had PLCOm2012 of less than 1·51% at 6 years, ever-smokers in the Prostate Lung Colorectal and Ovarian Cancer Screening Trial (PLCO) who met these criteria and their lung cancer incidence were applied to the ILST sample size for the mean follow-up occurring in the ILST. This trial is registered at ClinicalTrials.gov, NCT02871856. Study enrolment is almost complete. FINDINGS Between June 17, 2015, and Dec 29, 2020, 5819 participants from the International Lung Screening Trial (ILST) were enrolled on the basis of meeting USPSTF2013 criteria or the PLCOm2012 risk threshold of at least 1·51% at 6 years. The same number of individuals was selected for the PLCOm2012 model as for the USPSTF2013 criteria (4540 [78%] of 5819). After a mean follow-up of 2·3 years (SD 1·0), 135 lung cancers occurred in 4540 USPSTF2013-positive participants and 162 in 4540 participants included in the PLCOm2012 of at least 1·70% at 6 years group (cancer sensitivity difference 15·8%, 95% CI 10·7-22·1%; absolute odds ratio 4·00, 95% CI 1·89-9·44; p<0·0001). Compared to USPSTF2013-positive individuals, PLCOm2012-selected participants were older (mean age 65·7 years [SD 5·9] vs 63·3 years [5·7]; p<0·0001), had more comorbidities (median 2 [IQR 1-3] vs 1 [1-2]; p<0·0001), and shorter life expectancy (13·9 years [95% CI 12·8-14·9] vs 14·8 [13·6-16·0] years). Model-based difference in cumulative life expectancies for those diagnosed with lung cancer were higher in those who had PLCOm2012 risk of at least 1·70% at 6 years than individuals who were USPSTF2013-positive (2248·6 years [95% CI 2089·6-2425·9] vs 2000·7 years [1841·2-2160·3]; difference 247·9 years, p=0·015). INTERPRETATION PLCOm2012 appears to be more efficient than the USPSTF2013 criteria for selecting individuals to enrol into lung cancer screening programmes and should be used for identifying high-risk individuals who benefit from the inclusion in these programmes. FUNDING Terry Fox Research Institute, The UBC-VGH Hospital Foundation and the BC Cancer Foundation, the Alberta Cancer Foundation, the Australian National Health and Medical Research Council, Cancer Research UK and a consortium of funders, and the Roy Castle Lung Cancer Foundation for the UK Lung Screen Uptake Trial.
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Affiliation(s)
- Martin C Tammemägi
- Department of Health Sciences, Brock University, St Catharines, ON, Canada.
| | - Mamta Ruparel
- Lungs for Living, UCL Respiratory, Department of Medicine, University College London, London, UK
| | - Alain Tremblay
- Division of Respiratory Medicine & Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Renelle Myers
- BC Cancer Research Centre, Integrative Oncology, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - John Mayo
- Department of Radiology, Vancouver, BC, Canada
| | - John Yee
- Department of Thoracic Surgery, Vancouver, BC, Canada
| | | | - Ren Yuan
- Vancouver Coastal Health, Vancouver, BC, Canada; Department of Radiology, BC Cancer, Vancouver, BC, Canada
| | - Sonya Cressman
- Centre for Epidemiology and Evaluation, SFU, Burnaby, BC, Canada
| | | | - Eric Bedard
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Paul MacEachern
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul Burrowes
- Department of Diagnostic Imaging, Foothills Medical Center, Calgary, AB, Canada
| | - Samantha L Quaife
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Henry Marshall
- The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Ian Yang
- The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Rayleen Bowman
- The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Linda Passmore
- The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Annette McWilliams
- Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Fraser Brims
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; Curtin Medical School, National Centre for Asbestos Related Diseases, Institute for Respiratory Health, Perth, WA, Australia
| | - Kuan Pin Lim
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Lin Mo
- Royal Darwin Hospital, Tiwi, NT, Australia
| | - Stephen Melsom
- Department of Medical Imaging, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Bann Saffar
- Department of Medical Imaging, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Mark Teh
- Department of Medical Imaging, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Ramon Sheehan
- Department of Medical Imaging, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Yijin Kuok
- Department of Medical Imaging, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Renee Manser
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Louis Irving
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Daniel Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Mark McCusker
- Department of Radiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Diane Pascoe
- Department of Radiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Paul Fogarty
- Epworth Internal Medicine Clinical Institute, Melbourne VIC, Australia
| | - Emily Stone
- St Vincent's Hospital, Kinghorn Cancer Centre, University of New South Wales, Sydney, NSW, Australia
| | - David C L Lam
- Department of Medicine, University of Hong Kong, Hong Kong
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, University of Hong Kong, Hong Kong
| | | | | | - Rayjean J Hung
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Samuel M Janes
- Lungs for Living, UCL Respiratory, Department of Medicine, University College London, London, UK
| | - Kwun Fong
- The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Stephen Lam
- BC Cancer Research Centre, Integrative Oncology, Vancouver, BC, Canada
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Dickson JL, Horst C, Nair A, Tisi S, Prendecki R, Janes SM. Hesitancy around low-dose CT screening for lung cancer. Ann Oncol 2022; 33:34-41. [PMID: 34555501 DOI: 10.1016/j.annonc.2021.09.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 09/07/2021] [Accepted: 09/12/2021] [Indexed: 12/17/2022] Open
Abstract
Lung cancer is the leading cause of cancer death worldwide. The absence of symptoms in early-stage (I/II) disease, when curative treatment is possible, results in >70% of cases being diagnosed at late stage (III/IV), when treatment is rarely curative. This contributes greatly to the poor prognosis of lung cancer, which sees only 16.2% of individuals diagnosed with the disease alive at 5 years. Early detection is key to improving lung cancer survival outcomes. As a result, there has been longstanding interest in finding a reliable screening test. After little success with chest radiography and sputum cytology, in 2011 the United States National Lung Screening Trial demonstrated that annual low-dose computed tomography (LDCT) screening reduced lung cancer-specific mortality by 20%, when compared with annual chest radiography. In 2020, the NELSON study demonstrated an even greater reduction in lung cancer-specific mortality for LDCT screening at 0, 1, 3 and 5.5 years of 24% in men, when compared to no screening. Despite these impressive results, a call to arms in the 2017 European position statement on lung cancer screening (LCS) and the widespread introduction across the United States, there was, until recently, no population-based European national screening programme in place. We address the potential barriers and outstanding concerns including common screening foes, such as false-positive tests, overdiagnosis and the negative psychological impact of screening, as well as others more unique to LDCT LCS, including appropriate risk stratification of potential participants, radiation exposure and incidental findings. In doing this, we conclude that whilst the evidence generated from ongoing work can be used to refine the screening process, for those risks which remain, appropriate and acceptable mitigations are available, and none should serve as barriers to the implementation of national unified LCS programmes across Europe and beyond.
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Affiliation(s)
- J L Dickson
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - C Horst
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - A Nair
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; Department of Radiology, University College London Hospital, London, UK
| | - S Tisi
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - R Prendecki
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - S M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; Department of Thoracic Medicine, University College London Hospital, London, UK.
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Field JK, Vulkan D, Davies MP, Baldwin DR, Brain KE, Devaraj A, Eisen T, Gosney J, Green BA, Holemans JA, Kavanagh T, Kerr KM, Ledson M, Lifford KJ, McRonald FE, Nair A, Page RD, Parmar MK, Rassl DM, Rintoul RC, Screaton NJ, Wald NJ, Weller D, Whynes DK, Williamson PR, Yadegarfar G, Gabe R, Duffy SW. Lung cancer mortality reduction by LDCT screening: UKLS randomised trial results and international meta-analysis. THE LANCET REGIONAL HEALTH. EUROPE 2021; 10:100179. [PMID: 34806061 PMCID: PMC8589726 DOI: 10.1016/j.lanepe.2021.100179] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The NLST reported a significant 20% reduction in lung cancer mortality with three annual low-dose CT (LDCT) screens and the Dutch-Belgian NELSON trial indicates a similar reduction. We present the results of the UKLS trial. METHODS From October 2011 to February 2013, we randomly allocated 4 055 participants to either a single invitation to screening with LDCT or to no screening (usual care). Eligible participants (aged 50-75) had a risk score (LLPv2) ≥ 4.5% of developing lung cancer over five years. Data were collected on lung cancer cases to 31 December 2019 and deaths to 29 February 2020 through linkage to national registries. The primary outcome was mortality due to lung cancer. We included our results in a random-effects meta-analysis to provide a synthesis of the latest randomised trial evidence. FINDINGS 1 987 participants in the intervention and 1 981 in the usual care arms were followed for a median of 7.3 years (IQR 7.1-7.6), 86 cancers were diagnosed in the LDCT arm and 75 in the control arm. 30 lung cancer deaths were reported in the screening arm, 46 in the control arm, (relative rate 0.65 [95% CI 0.41-1.02]; p=0.062). The meta-analysis indicated a significant reduction in lung cancer mortality with a pooled overall relative rate of 0.84 (95% CI 0.76-0.92) from nine eligible trials. INTERPRETATION The UKLS trial of single LDCT indicates a reduction of lung cancer death of similar magnitude to the NELSON and NLST trials and was included in a meta-analysis of nine randomised trials which provides unequivocal support for lung cancer screening in identified risk groups. FUNDING NIHR Health Technology Assessment programme; NIHR Policy Research programme; Roy Castle Lung Cancer Foundation.
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Affiliation(s)
- John K. Field
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK
| | - Daniel Vulkan
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Michael P.A. Davies
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK
| | - David R. Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - Kate E. Brain
- Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London, and National Heart and Lung Institute, Imperial College, London, UK
| | - Tim Eisen
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - John Gosney
- Department of Pathology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Beverley A. Green
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK
| | - John A. Holemans
- Department of Radiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - Keith M. Kerr
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Martin Ledson
- Department of Respiratory Medicine, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Kate J. Lifford
- Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Fiona E. McRonald
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK
| | - Arjun Nair
- Department of Radiology, University College, London Hospital, London, UK
| | - Richard D. Page
- Department of Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - Doris M. Rassl
- Department of Pathology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Robert C. Rintoul
- Department of Thoracic Oncology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Nicholas J. Screaton
- Department of Thoracic Oncology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Nicholas J. Wald
- Faculty of Population Health Sciences, University College London, London, UK
| | - David Weller
- School of Clinical Sciences and Community Health, University of Edinburgh, Edinburgh, UK
| | - David K. Whynes
- School of Economics, University of Nottingham, Nottingham, UK
| | | | - Gasham Yadegarfar
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK
| | - Rhian Gabe
- Center for Evaluation and Methods, Wolfson Institute of Population Health. Queen Mary University of London, London, UK
| | - Stephen W. Duffy
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Balata H, Ruparel M, O'Dowd E, Ledson M, Field JK, Duffy SW, Quaife SL, Sharman A, Janes S, Baldwin D, Booton R, Crosbie PAJ. Analysis of the baseline performance of five UK lung cancer screening programmes. Lung Cancer 2021; 161:136-140. [PMID: 34583222 DOI: 10.1016/j.lungcan.2021.09.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/26/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Low-dose CT (LDCT) screening reduces lung cancer specific mortality. Several countries, including the UK, are evaluating the clinical impact and cost-effectiveness of LDCT screening using the latest evidence. In this paper we report baseline screening performance from five UK-based lung cancer screening programmes. METHODS Data was collected at baseline from each screening programme. Measures of performance included prevalence of screen detected lung cancer, rate of surveillance imaging for indeterminate findings and surgical resection rates. Screening related harms were assessed by measuring false positive rates, number of invasive tests with associated complications in individuals without lung cancer and benign surgical resection rates. RESULTS A total of 11,148 individuals had a baseline LDCT scan during the period of analysis (2011 to 2020). Overall, 84.7% (n = 9,440) of baseline LDCT scans were categorised as negative, 11.1% (n = 1,239) as indeterminate and 4.2% (n = 469) as positive. The prevalence of screen detected lung cancer was 2.2%, ranging between 1.8% and 4.4% for individual programmes. The surgical resection rate was 66% (range 46% to 83%) and post-surgical 90-day mortality for those with lung cancer 1.2% (n = 2/165). The false positive rate was 2% (n = 219/10,898) and of those with a positive result, one in two had lung cancer diagnosed (53.3%). An invasive test was required in 0.6% (n = 61/10,898) of screening attendees without lung cancer; there were no associated major complications or deaths. The benign surgical resection rate was 4.6% (n = 8/173), equating to 0.07% of the screened population. DISCUSSION The performance of UK-based lung cancer screening programmes, delivered within or aligned to the National Health Service, compares favourably to published clinical trial data. Reported harms, including false positive and benign surgical resection rates are low. Ongoing monitoring of screening performance is vital to ensure standards are maintained and harms minimised.
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Affiliation(s)
- Haval Balata
- Manchester Thoracic Oncology Centre (MTOC), Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Emma O'Dowd
- Department of Respiratory Medicine, Nottingham City Hospital, Nottingham, UK
| | - Martin Ledson
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - John K Field
- Molecular and Clinical Cancer Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Samantha L Quaife
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Anna Sharman
- Manchester Thoracic Oncology Centre (MTOC), Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sam Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - David Baldwin
- Department of Respiratory Medicine, Nottingham City Hospital, Nottingham, UK
| | - Richard Booton
- Manchester Thoracic Oncology Centre (MTOC), Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Philip A J Crosbie
- Manchester Thoracic Oncology Centre (MTOC), Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Defining growth in small pulmonary nodules using volumetry: results from a "coffee-break" CT study and implications for current nodule management guidelines. Eur Radiol 2021; 32:1912-1920. [PMID: 34580748 PMCID: PMC8831344 DOI: 10.1007/s00330-021-08302-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/10/2021] [Accepted: 08/24/2021] [Indexed: 12/17/2022]
Abstract
Objectives
An increase in lung nodule volume on serial CT may represent true growth or measurement variation. In nodule guidelines, a 25% increase in nodule volume is frequently used to determine that growth has occurred; this is based on previous same-day, test–retest (coffee-break) studies examining metastatic nodules. Whether results from prior studies apply to small non-metastatic nodules is unknown. This study aimed to establish the interscan variability in the volumetric measurements of small-sized non-metastatic nodules. Methods Institutional review board approval was obtained for this study. Between March 2019 and January 2021, 45 adults (25 males; mean age 65 years, range 37–84 years) with previously identified pulmonary nodules (30–150 mm3) requiring surveillance, without a known primary tumour, underwent two same-day CT scans. Non-calcified solid nodules were measured using commercial volumetry software, and interscan variability of volume measurements was assessed using a Bland–Altman method and limits of agreement. Results One hundred nodules (range 28–170 mm3; mean 81.1 mm3) were analysed. The lower and upper limits of agreement for the absolute volume difference between the two scans were − 14.2 mm3 and 12.0 mm3 respectively (mean difference 1.09 mm3, range − 33–12 mm3). The lower and upper limits of agreement for relative volume difference were − 16.4% and 14.6% respectively (mean difference 0.90%, range − 24.1–32.8%). Conclusions The interscan volume variability in this cohort of small non-metastatic nodules was smaller than that in previous studies involving lung metastases of varying sizes. An increase of 15% in nodule volume on sequential CT may represent true growth, and closer surveillance of these nodules may be warranted. Key Points • In current pulmonary nodule management guidelines, a threshold of 25% increase in volume is required to determine that true growth of a pulmonary nodule has occurred. • This test–retest (coffee break) study has demonstrated that a smaller threshold of 15% increase in volume may represent true growth in small non-metastatic nodules. • Closer surveillance of some small nodules growing 15–25% over a short interval may be appropriate.
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Iball GR, Darby M, Gabe R, Crosbie PAJ, Callister MEJ. Establishing scanning protocols for a CT lung cancer screening trial in the UK. Br J Radiol 2021; 94:20201343. [PMID: 34555954 DOI: 10.1259/bjr.20201343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To develop a CT scanning protocol for lung cancer screening which achieved low radiation dose and a high level of objectively assessed image quality. METHODS An anthropomorphic chest phantom and a commercially available lung screening image quality phantom were scanned on a series of scan protocols from a previous UK lung screening pilot and on an alternative protocol. The chest phantom scans were used to assess the CT dose metrics on community-based mobile CT scanners and comparisons were made with published recommended doses. Scans of the image quality phantom were objectively assessed against the RSNA Quantitative Imaging Biomarkers Alliance (QIBA) recommendations. Protocol adjustments were made to ensure that the recommended dose and image quality levels were both achieved. RESULTS The alternative scan protocol yielded doses up to 72% lower than on the previously used protocols with a CTDIvol of 0.6mGy for the 55 kg equivalent phantom and 1.3mGy with an additional 6 cm of tissue equivalent material in place. Scans on the existing protocols failed on two of the QIBA image quality metrics (edge enhancement and 3D resolution aspect ratio). Following adjustments to the reconstruction parameters of the resulting image quality met all six QIBA recommendations. Radiologist review of phantom images with this scan protocol deemed them suitable for a lung screening trial. CONCLUSIONS Scan protocols yielding low radiation doses and high levels of objectively assessed image quality which meet published criteria can be established through the use of specific anthropomorphic and image quality phantoms, and are deliverable in community-based lung cancer screening. ADVANCES IN KNOWLEDGE Development of a standard methodology for establishing CT lung screening scanning protocolsUse of QIBA recommendations as objective image quality metricsStandardised lung phantoms are essential tools for setting up lung screening protocols.
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Affiliation(s)
- Gareth R Iball
- Department of Medical Physics & Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Michael Darby
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Rhian Gabe
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Philip A J Crosbie
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, England, United Kingdom
| | - Matthew E J Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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Lam S, Tammemagi M. Contemporary issues in the implementation of lung cancer screening. Eur Respir Rev 2021; 30:30/161/200288. [PMID: 34289983 DOI: 10.1183/16000617.0288-2020] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/08/2021] [Indexed: 12/24/2022] Open
Abstract
Lung cancer screening with low-dose computed tomography can reduce death from lung cancer by 20-24% in high-risk smokers. National lung cancer screening programmes have been implemented in the USA and Korea and are being implemented in Europe, Canada and other countries. Lung cancer screening is a process, not a test. It requires an organised programmatic approach to replicate the lung cancer mortality reduction and safety of pivotal clinical trials. Cost-effectiveness of a screening programme is strongly influenced by screening sensitivity and specificity, age to stop screening, integration of smoking cessation intervention for current smokers, screening uptake, nodule management and treatment costs. Appropriate management of screen-detected lung nodules has significant implications for healthcare resource utilisation and minimising harm from radiation exposure related to imaging studies, invasive procedures and clinically significant distress. This review focuses on selected contemporary issues in the path to implement a cost-effective lung cancer screening at the population level. The future impact of emerging technologies such as deep learning and biomarkers are also discussed.
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Affiliation(s)
- Stephen Lam
- British Columbia Cancer Agency, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Martin Tammemagi
- Dept of Health Sciences, Brock University, St Catharines, ON, Canada
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Implications of incidental findings from lung screening for primary care: data from a UK pilot. NPJ Prim Care Respir Med 2021; 31:36. [PMID: 34099737 PMCID: PMC8184811 DOI: 10.1038/s41533-021-00246-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/07/2021] [Indexed: 11/23/2022] Open
Abstract
Regional lung cancer screening (LCS) is underway in England, involving a “lung health check” (LHC) and low-dose CT scan for those at high risk of cancer. Incidental findings from LHCs or CTs are usually referred to primary care. We describe the proportion of participants referred from the West London LCS pilot to primary care, the indications for referral, the number of general practitioner (GP) attendances and consequent changes to patient management, and provide an estimated cost-burden analysis for primary care. A small proportion (163/1542, 10.6%) of LHC attendees were referred to primary care, primarily for suspected undiagnosed chronic obstructive pulmonary disease (55/163, 33.7%) or for QRISK® (63/163, 38.7%) assessment. Ninety one of 159 (57.2%) participants consenting to follow-up attended GP appointments; costs incurred by primary care were estimated at £5.69/LHC participant. Patient management changes occurred in only 36/159 (22.6%) referred participants. LHCs result in a small increase to primary care workload provided a strict referral protocol is adhered to. Changes to patient management arising from incidental findings referrals are infrequent.
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Ten Haaf K, van der Aalst CM, de Koning HJ, Kaaks R, Tammemägi MC. Personalising lung cancer screening: An overview of risk-stratification opportunities and challenges. Int J Cancer 2021; 149:250-263. [PMID: 33783822 PMCID: PMC8251929 DOI: 10.1002/ijc.33578] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/04/2021] [Accepted: 03/12/2021] [Indexed: 12/17/2022]
Abstract
Randomised clinical trials have shown the efficacy of computed tomography lung cancer screening, initiating discussions on whether and how to implement population‐based screening programs. Due to smoking behaviour being the primary risk‐factor for lung cancer and part of the criteria for determining screening eligibility, lung cancer screening is inherently risk‐based. In fact, the selection of high‐risk individuals has been shown to be essential in implementing lung cancer screening in a cost‐effective manner. Furthermore, studies have shown that further risk‐stratification may improve screening efficiency, allow personalisation of the screening interval and reduce health disparities. However, implementing risk‐based lung cancer screening programs also requires overcoming a number of challenges. There are indications that risk‐based approaches can negatively influence the trade‐off between individual benefits and harms if not applied thoughtfully. Large‐scale implementation of targeted, risk‐based screening programs has been limited thus far. Consequently, questions remain on how to efficiently identify and invite high‐risk individuals from the general population. Finally, while risk‐based approaches may increase screening program efficiency, efficiency should be balanced with the overall impact of the screening program. In this review, we will address the opportunities and challenges in applying risk‐stratification in different aspects of lung cancer screening programs, as well as the balance between screening program efficiency and impact.
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Affiliation(s)
- Kevin Ten Haaf
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Carlijn M van der Aalst
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Martin C Tammemägi
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
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43
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Lebrett MB, Crosbie EJ, Smith MJ, Woodward ER, Evans DG, Crosbie PAJ. Targeting lung cancer screening to individuals at greatest risk: the role of genetic factors. J Med Genet 2021; 58:217-226. [PMID: 33514608 PMCID: PMC8005792 DOI: 10.1136/jmedgenet-2020-107399] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 12/24/2022]
Abstract
Lung cancer (LC) is the most common global cancer. An individual’s risk of developing LC is mediated by an array of factors, including family history of the disease. Considerable research into genetic risk factors for LC has taken place in recent years, with both low-penetrance and high-penetrance variants implicated in increasing or decreasing a person’s risk of the disease. LC is the leading cause of cancer death worldwide; poor survival is driven by late onset of non-specific symptoms, resulting in late-stage diagnoses. Evidence for the efficacy of screening in detecting cancer earlier, thereby reducing lung-cancer specific mortality, is now well established. To ensure the cost-effectiveness of a screening programme and to limit the potential harms to participants, a risk threshold for screening eligibility is required. Risk prediction models (RPMs), which provide an individual’s personal risk of LC over a particular period based on a large number of risk factors, may improve the selection of high-risk individuals for LC screening when compared with generalised eligibility criteria that only consider smoking history and age. No currently used RPM integrates genetic risk factors into its calculation of risk. This review provides an overview of the evidence for LC screening, screening related harms and the use of RPMs in screening cohort selection. It gives a synopsis of the known genetic risk factors for lung cancer and discusses the evidence for including them in RPMs, focusing in particular on the use of polygenic risk scores to increase the accuracy of targeted lung cancer screening.
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Affiliation(s)
- Mikey B Lebrett
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK.,Prevention and Early Detection Theme, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Emma J Crosbie
- Prevention and Early Detection Theme, NIHR Manchester Biomedical Research Centre, Manchester, UK.,Division of Cancer Sciences, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| | - Miriam J Smith
- Prevention and Early Detection Theme, NIHR Manchester Biomedical Research Centre, Manchester, UK.,Manchester Centre for Genomic Medicine, St Mary's Hospital, Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Emma R Woodward
- Prevention and Early Detection Theme, NIHR Manchester Biomedical Research Centre, Manchester, UK.,Manchester Centre for Genomic Medicine, St Mary's Hospital, Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, UK
| | - D Gareth Evans
- Prevention and Early Detection Theme, NIHR Manchester Biomedical Research Centre, Manchester, UK.,Manchester Centre for Genomic Medicine, St Mary's Hospital, Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Philip A J Crosbie
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK .,Prevention and Early Detection Theme, NIHR Manchester Biomedical Research Centre, Manchester, UK.,Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Ding M, Zha L, Wang H, Liu J, Chen P, Zhao Y, Jiang L, Li Y, Ouyang R, Miao Y. A frogspawn-like Ag@C core–shell structure for an ultrasensitive label-free electrochemical immunosensing of carcinoembryonic antigen in blood plasma. RSC Adv 2021; 11:16339-16350. [PMID: 35479148 PMCID: PMC9030918 DOI: 10.1039/d1ra00910a] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/18/2021] [Indexed: 12/31/2022] Open
Abstract
Novel frogspawn-like Ag@C nanoparticles were successfully used to fabricate an ultrasensitive electrochemical immunosensing platform toward CEA in human blood samples.
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Affiliation(s)
- Mengkui Ding
- Institute of Bismuth Science
- University of Shanghai for Science and Technology
- Shanghai 200093
- P. R. China
| | - Ling Zha
- Department of Laboratory Diagnosis
- Changhai Hospital
- Naval Medical University
- Shanghai 20043
- P. R. China
| | - Hui Wang
- Institute of Bismuth Science
- University of Shanghai for Science and Technology
- Shanghai 200093
- P. R. China
| | - Jinyao Liu
- Institute of Bismuth Science
- University of Shanghai for Science and Technology
- Shanghai 200093
- P. R. China
| | - Peiwu Chen
- Institute of Bismuth Science
- University of Shanghai for Science and Technology
- Shanghai 200093
- P. R. China
| | - Yuefeng Zhao
- Institute of Bismuth Science
- University of Shanghai for Science and Technology
- Shanghai 200093
- P. R. China
| | - Lan Jiang
- Institute of Bismuth Science
- University of Shanghai for Science and Technology
- Shanghai 200093
- P. R. China
| | - Yuhao Li
- Institute of Bismuth Science
- University of Shanghai for Science and Technology
- Shanghai 200093
- P. R. China
| | - Ruizhuo Ouyang
- Institute of Bismuth Science
- University of Shanghai for Science and Technology
- Shanghai 200093
- P. R. China
| | - Yuqing Miao
- Institute of Bismuth Science
- University of Shanghai for Science and Technology
- Shanghai 200093
- P. R. China
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45
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The challenges of implementing low-dose computed tomography for lung cancer screening in low- and middle-income countries. NATURE CANCER 2020; 1:1140-1152. [PMID: 35121933 DOI: 10.1038/s43018-020-00142-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/09/2020] [Indexed: 12/12/2022]
Abstract
Lung cancer accounts for an alarming human and economic burden in low- and middle-income countries (LMICs). Recent landmark trials from high-income countries (HICs) by demonstrating that low-dose computed tomography (LDCT) screening effectively reduces lung cancer mortality have engendered enthusiasm for this approach. Here we examine the effectiveness and affordability of LDCT screening from the viewpoint of LMICs. We consider resource-restricted perspectives and discuss implementation challenges and strategies to enhance the feasibility and cost-effectiveness of LDCT screening in LMICs.
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Murray RL, Brain K, Britton J, Quinn-Scoggins HD, Lewis S, McCutchan GM, Quaife SL, Wu Q, Ashurst A, Baldwin D, Crosbie PAJ, Neal RD, Parrott S, Rogerson S, Thorley R, Callister ME. Yorkshire Enhanced Stop Smoking (YESS) study: a protocol for a randomised controlled trial to evaluate the effect of adding a personalised smoking cessation intervention to a lung cancer screening programme. BMJ Open 2020; 10:e037086. [PMID: 32912948 PMCID: PMC7485260 DOI: 10.1136/bmjopen-2020-037086] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Integration of smoking cessation (SC) into lung cancer screening is essential to optimise clinical and cost effectiveness. The most effective way to use this 'teachable moment' is unclear. The Yorkshire Enhanced Stop Smoking study will measure the effectiveness of an SC service integrated within the Yorkshire Lung Screening Trial (YLST) and will test the efficacy of a personalised SC intervention, incorporating incidental findings detected on the low-dose CT scan performed as part of YLST. METHODS AND ANALYSIS Unless explicitly declined, all smokers enrolled in YLST will see an SC practitioner at baseline and receive SC support over 4 weeks comprising behavioural support, pharmacotherapy and/or a commercially available e-cigarette. Eligible smokers will be randomised (1:1 in permuted blocks of random size up to size 6) to receive either an enhanced, personalised SC support package, including CT scan images, or continued standard best practice. Anticipated recruitment is 1040 smokers (January 2019-December 2020). The primary objective is to measure 7-day point prevalent carbon monoxide (CO) validated SC after 3 months. Secondary outcomes include CO validated cessation at 4 weeks and 12 months, self-reported continuous cessation at 4 weeks, 3 months and 12 months, attempts to quit smoking and changes in psychological variables, including perceived risk of lung cancer, motivation to quit smoking tobacco, confidence and efficacy beliefs (self and response) at all follow-up points. A process evaluation will explore under which circumstances and on which groups the intervention works best, test intervention fidelity and theory test the mechanisms of intervention impact. ETHICS AND DISSEMINATION This study has been approved by the East Midlands-Derby Research Ethics Committee (18/EM/0199) and the Health Research Authority/Health and Care Research Wales. Results will be disseminated through publication in peer-reviewed scientific journals, presentation at conferences and via the YLST website. TRIAL REGISTRATION NUMBERS ISRCTN63825779, NCT03750110.
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Affiliation(s)
- Rachael L Murray
- Division of Epidemiology & Public Health, Faculty of Medicine, University of Nottingham, Nottingham, United Kingdom
- UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, United Kingdom
| | - Kate Brain
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - John Britton
- Division of Epidemiology & Public Health, Faculty of Medicine, University of Nottingham, Nottingham, United Kingdom
- UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, United Kingdom
| | | | - Sarah Lewis
- Division of Epidemiology & Public Health, Faculty of Medicine, University of Nottingham, Nottingham, United Kingdom
- UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, United Kingdom
| | - Grace M McCutchan
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Samantha L Quaife
- Research Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Qi Wu
- Department of Health Sciences, University of York, York, UK
| | - Alex Ashurst
- Department of Radiology, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - David Baldwin
- Deaprtment of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Philip A J Crosbie
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Wythenshawe, UK
| | - Richard D Neal
- Institute of Health Science, University of Leeds, Leeds, United Kingdom
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Suzanne Rogerson
- Research and Innivation CSU, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Rebecca Thorley
- Division of Epidemiology & Public Health, Faculty of Medicine, University of Nottingham, Nottingham, United Kingdom
- UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, United Kingdom
| | - Matthew Ej Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, United Kingdom
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