Working towards a national lung cancer screening programme in very high risk Hodgkin lymphoma (HL) survivors to improve prevention and early detection

Narrative

Survivors of Hodgkin lymphoma (HL) are at increased risk of developing treatment-related late effects including second cancers, most commonly of the breast and lung. Our group has successfully implemented national screening in partnership with NHS England for early detection of breast cancer after treatment for HL (see BARD) and is conducting follow-on research to improve risk prediction using machine learning of scans to predict radiation exposure. Our goal is to develop similar screening programmes for lung cancer, which is the next most common and the most fatal second cancer in HL survivors as most patients are diagnosed at an advanced and incurable stage.

HL survivors don't currently qualify for Targeted Lung Health Checks that were launched in England in September 2022. Furthermore, most are unaware that they are at higher risk of developing lung cancer. With funding from Roy Castle Lung Cancer Foundation and The Christie Charity, we conducted studies to capture survivor views, confirming high levels of enthusiasm for screening and a high likely uptake rate, and developed a decision aid to support HL survivors to make informed decisions about whether to take part in lung cancer screening.

The decision aid was tested together with standard screening protocols in a pilot lung cancer screening study in HL survivors at The Christie. Of 102 asymptomatic screened participants (83% uptake rate), two were diagnosed with lung cancer – one at an early stage that was treated surgically with curative intent and another at an advanced stage that was treated with chemotherapy.

The study validated the decision aid and demonstrated the feasibility of lung cancer screening for HL survivors to improve outcomes through early diagnosis.

We are now engaging with NHS England and collaborators across the UK in a Manchester BRC Living With and Beyond Cancer themed initiative to test the feasibility of creating a national risk register to direct targeted screening within a national screening programme for very high risk HL survivors.

Category of impact	Health and wellbeing
Impact level	Engagement