The Impact of a Community Based Lung Cancer Screening Programme

Abstract

Lung cancer is the commonest cause of cancer-related death globally. Screening with low-dose computed tomography (LDCT) can reduce lung cancer mortality. Benefit is greatest in those at highest risk such as current smokers from areas of high socio-economic deprivation yet screening uptake in these populations remains a challenge. The aim of this thesis was to assess the impact of a Lung Health Check (LHC) based lung cancer screening programme set within the community in deprived areas of the city. Ever smokers, aged 55-74, registered at 14 participating GP practices in deprived areas of Manchester were invited to attend and have a free Lung Health Check in mobile units located in convenient community settings. Lung cancer risk score (PLCOM2012), respiratory symptoms and spirometry were assessed as part of the LHC. Those at high risk (PLCOM2012 1.51% or above) were invited for annual LDCT screening over two screening rounds starting with an immediate LDCT in a co-located mobile CT scanner. All active smokers were provided with brief smoking cessation advice. Cardiovascular disease (CVD) risk (QRISK2 score) was assessed in those attending the second round of screening. Demand exceeded capacity and all appointments were booked within a few days. 2,541 individuals attended and had a LHC. Mean age was 64.1 and 51.0% were female. 74.5% of participants were ranked in the lowest quintile of deprivation in England. The majority of individuals had left school by the age of 16 (81.8%), most without gaining any O levels (61.7%). 56.2% (n=1,429) were defined as high-risk and offered LDCT screening. 1,384 individuals underwent LDCT screening at baseline and 1,194 attended the second round (screening adherence 90.2%). Cumulative lung cancer detection rate was 4.3% (3% prevalence; 1.6% incidence) of which 80% were early stage (I-II) and 88.5% were radically treatable. 83.3% of individuals diagnosed with lung cancer received radical treatment. Overall 4.3% of screening scans were positive. The false positive rate was 44.5% of those seen in the lung cancer clinic and 3.5% of the entire screened population. 18.6% of attendees had evidence of airflow obstruction with no previous diagnosis of COPD of which half (9.9%) were symptomatic. A third (33.7%) of second round participants were at high risk of CVD (QRISK2 score 10% or above) but not receiving primary prevention with statin therapy as recommended by national guidelines. One in ten (10.2%) smokers quit smoking between the first and second rounds of screening. Taking lung cancer screening into the deprived communities can identify and reach those at most risk. Screening identified predominantly early stage disease which was radically treatable. A LHC approach provided an opportunity to address other smoking related morbidities including undiagnosed COPD, CVD prevention and smoking cessation.

Date of Award	1 Aug 2020
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Richard Booton (Supervisor) & Philip Crosbie (Supervisor)