Pilot lung health check schemes in London, Liverpool and Manchester demonstrate that it is possible to “reach the unreachable” and diagnose lung cancer early in people at high risk.
Delegates at the BTS Winter Meeting heard that targeted screening, intended to reach older people from deprived communities who are current smokers, resulted in cancer diagnosis rates of around 2% to 3%, with high rates of early diagnosis (80% in Manchester) and resectable cancers.
One key aim was to “diminish the fear and fatalism” around lung cancer, said Dr Martin Ledsom, consultant at Liverpool Heart and Chest Hospital, who was presenting data from the Liverpool Healthy Lung Project to the conference. “I wanted to change the messaging – it is a curable disease.”
He said that including tests for COPD raises the value of the project for commissioners and participants.
The three pilots used GP data, including smoking data, to identify patients likely to be eligible for CT scans. Patients were then approached by letter and invited to attend a “lung health check”.
In Manchester, these checks (and any CT scans) took place during one appointment, in mobile units sited in supermarket carparks. In Liverpool, initial tests were carried out by nurses sited in GP practices, with patients then referred to CT scanning units.
Dr Mamta Ruperal, clinical fellow at UCL London, said their pilot scheme in three London Clinical Commissioning Groups (CCGs) used a “novel invitation strategy” in which the screening was presented as “a new NHS service – an MOT for your lungs. Don’t talk about smoking or cancer, so you don’t scare people.”
Dr Ruperal’s group compared the performance of three screening strategies – one based simply on age and smoking history, the Liverpool Lung Pathway v2 (LLPv2) risk assessment of lung cancer risk over 5 years, and the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial (PLCO) risk assessment. They found the LLPv2 and PLCO risk assessments performed best.
“Risk assessment is definitely the way to go if you are doing just CT screening,” she said. “It’s difficult to say which [of the two] is better but risk prediction is better than smoking history only.”