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19th December 2023
The UK’s devolved nations could detect greater numbers of lung cancer cases with improved screening programmes, new analyses by Cancer Research UK have found as the charity calls for governments to ’urgently implement’ such programmes.
Lung cancer is the leading cause of cancer death in England, Scotland, Wales and Northern Ireland and smokers and former smokers aged 55-74 are at greatest risk.
In November 2022, the National Screening Committee (NSC) recommended that everyone in this group be screened but, to date, only England has initiated a screening programme on this advice.
Almost 900,000 people were invited for checks during the pilot stages in England. Of the 200,000 scans carried out, more than 2,000 people were detected as having lung cancer, and 76% of those were identified at an earlier stage (stage 1 or 2) compared to 29% identified outside of the pilot programme in 2019.
Cancer Research UK’s latest analyses suggests that equivalent lung cancer screening programmes in the devolved nations could diagnose around 4,000 more lung cancer patients in Scotland at an early stage over the next decade, as well as 2,400 more people in Wales and 1,400 in Northern Ireland.
If just 50% of eligible people took part in screening, earlier lung cancer diagnosis could save 2,300 lives in Scotland, 1,000 lives in Wales and 600 lives in Northern Ireland over the next 10 years, Cancer Research UK said.
Professor David Weller, professor of general practice at the University of Edinburgh, believes a nationwide screening programme ’has the potential to be a game changer when it comes to reducing the burden of lung cancer in Scotland’.
He said: ’For too long, lung cancer has been perceived as a disease you can’t do anything about, but we know that diagnosis at an early stage really can make a difference.
’Major trials of targeted lung cancer screening show significant reductions in mortality from lung cancer. Pilot studies in the UK and internationally consistently show people being diagnosed with lung cancer at an earlier stage.’
In Scotland, a pilot project called LUNGSCOT – of which Professor Weller is the principal investigator – is exploring the challenges for local lung cancer screening. It is running in Lothian with funding released for Grampian, Greater Glasgow and Clyde, and the Highlands and Islands.
A pilot is also running in Cwm Taf Morgannwg in Wales, where charities including Cancer Research UK are running a public petition in the hopes of raising the issue in the Senedd.
In Northern Ireland, there are no plans or pilots to report due to the lack of a Northern Irish Executive following the 2022 elections. That said, authors of the Northern Ireland Cancer Strategy 2022-2032 have said they intend to implement all NSC recommendations.
Debbie King, Cancer Research UK’s senior external affairs manager in the devolved nations, said: ’Lung screening matters because it means more people can be diagnosed at an earlier stage, when treatment is more likely to be successful.
’A fully-funded national targeted lung cancer screening programme in Northern Ireland, Scotland and Wales is a real chance to reduce the toll of this disease.
’There have been big improvements in how we diagnose and treat other forms of cancer, but long-term lung cancer survival in the UK isn’t much higher than it was 50 years ago. This is unacceptable when evidence shows that earlier diagnosis through targeted lung cancer screening can potentially help thousands of people live longer healthier lives.’
These latest analyses were published shortly after Cancer Research UK released its manifesto for reducing cancer deaths by 20,000 a year by 2040.
While overall cancer deaths have halved over the last 50 years, progress is at risk of stalling in the UK, the charity said.
As part of the manifesto, Cancer Research UK has called on the next UK Government to address variation in treatment across different geographical areas, which includes optimising cancer screening programmes and accelerating the roll-out of the lung cancer screening programme in England.
On the manifesto, former national cancer director at the Department of Health and chair of the National Screening Committee, Professor Sir Mike Richards, said: ’Cancer outcomes in the UK are lagging behind comparable countries like Denmark. We need consistent funding and long-term strategies to make the UK the best in the world for cancer survival.’
26th June 2023
All smokers and ex-smokers aged 55-74 will have their risk of cancer assessed in the England’s first-ever national lung cancer screening programme.
The programme will be based on the Targeted Lung Health Check (TLHC) programme, which has been piloted in parts of England.
Under the plans, which will cost £270m annually once fully implemented, GP records will be used to identify patients for screening.
The first phase of the lung cancer screening scheme will reach 40% of the eligible population by March 2025, with the aim of 100% coverage by March 2030, the Government’s announcement said.
Patients will have their risk of cancer assessed based on their smoking history and other factors and those considered high risk will be invited for specialist scans every two years.
It is estimated the rollout will mean 325,000 people will be eligible for a first scan each year with 992,000 scans expected per year in total.
The UK National Screening Committee recommended in November that all four nations in the UK should implement a national lung cancer screening programme.
It said the TLHC programme would be a ‘practical starting point’ for implementation in England while a UK-wide programme needed ‘more modelling’.
During the pilots, approximately 70% of the screening took place in mobile units to ‘ensure easy access’ and ‘focused on more deprived areas where people are four times more likely to smoke’.
Almost 900,000 people were invited for checks, 375,000 risk assessments made and 200,000 scans were carried out.
Of these, more than 2,000 people were detected as having lung cancer, with 76% identified at an earlier stage compared to 29% identified outside of the pilot programme in 2019.
Urging patients receiving an invitation for lung cancer screening to go to their GP and take it up, NHS chief executive Amanda Pritchard said: ‘The NHS lung trucks programme is already delivering life-changing results, with people living in the most deprived areas now more likely to be diagnosed at an earlier stage, giving them a better chance of successful treatment.’
Health secretary Steve Barclay said: ‘Through our [lung cancer] screening programme we are now seeing more diagnoses at stage 1 and stage 2 in the most deprived communities, which is both a positive step and a practical example of how we are reducing health inequalities.
‘Rolling this out further will prolong lives by catching cancer earlier and reducing the levels of treatment required not just benefiting the patient but others waiting for treatment.
‘I am determined to combat cancer on all fronts through better prevention, detection, treatment and research.‘
Cancer Research UK’s chief executive, Michelle Mitchell, said: ‘This is really positive news for a cancer type that takes more lives than any other. Targeted lung screening across England could diagnose people most at risk at an earlier stage, when treatment is more likely to be successful.
‘For the screening programme to succeed, the UK Government must ensure that sufficient diagnostic equipment and staff are in place – a comprehensive and fully-funded NHS workforce plan for England will be vital to this.
‘Given smoking is the leading cause of lung cancer, it’s good to see that smoking cessation will be part of the programme. This needs to be embedded across all sites and stop smoking services must be properly funded to ensure people can quit smoking for good.
‘Other UK nations now need to follow suit to ensure everyone eligible can benefit from these potentially lifesaving lung checks.‘
A version of this story was originally published by our sister publication Pulse.
1st February 2023
US and Taiwanese researchers have shown that the use of a single low-dose computed tomography (CT) scan, together with a deep learning algorithm, allows for a prediction of an individual’s risk of lung cancer over the next six years.
The use of low-dose CT screening has been shown to reduce mortality from lung cancer. Such screening allows for the early detection of the disease and hence the potential for better patient outcomes, although it has been suggested that the current screening guidelines might overlook vulnerable populations with a disproportionate lung cancer burden. Nevertheless, the efficiency of lung cancer screening could be improved by individualising the assessment of future cancer risk. The problem is determining how this can achieved. To date, there are some data to support the use of clinical risk assessment models that incorporate various factors compared to simply using age and cumulative smoking exposure. However, there are enormous possibilities created by greater use of artificial intelligence and deep learning models. In fact, it has become possible to utilise low-dose CT scan results and the presence of pulmonary nodules, into a model and to therefore optimise the screening process. But how useful are other pieces of information gathered from a CT scan beyond the presence of nodules, and could this other information be used by a deep learning model to predict future cancer risk.
This was the aim of the current study in which researchers developed a model, which they termed ‘Sybil’ using the entire volumetric low-dose CT data, without clinical and demographic information, to predict an individual’s future cancer risk. Sybil was able to run in the background of a radiology reading station and did not require annotation by a radiologist. The model was validated using information from three independent screening datasets which included individuals who were non-smokers.
In total, data were retrieved from over 27,000 patients held in three separate databases. Sybil achieved an area under the curve (AUC) of 0.92, 0.86 and 0.94, for the 1-year prediction of lung cancer for each of these datasets. In addition, the concordance indices over 6 years were 0.75, 0.81 and 0.80 for the same three data sets.
The authors concluded that Sybil was able to accurately predict individual’s future risk of lung cancer based on a single low-dose CT scan and called for further studies to better understand Sybil’s clinical application.
Citation
Mikheal PG et al. Sybil: a validated Deep learning model to predict future lung cancer risk from a single low-dose chest computed tomography. Clin Oncol 2023
4th August 2022
The lung cancer risk of both current light and former heavy smokers for whom screening with a computer tomography (CT) scan is not currently recommended appears to be 10-folder higher than those who have never smoked according to the findings of a study by US researchers.
The World Health Organization estimates that across the globe in 2020, there were 2.21 million cases of lung cancer and which led to 1.8 million deaths. Thus attempts to screen for the early signs of lung cancer might potentially reduce the number of lung cancer deaths.
The development of low-dose helical computed tomography (CT) scanning has shown that low-dose CT enables the detection of many lung cancer tumours at an early stage. In fact, a recent trial concluded that among high-risk individuals who underwent CT screening, lung-cancer mortality was significantly lower compared to those who did not undergo screening.
Consequently, screening recommendations with low-dose computed tomography (LDCT) have been produced and suggest annual screening for adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening, however, is not advocated for former smokers with a 20 pack-year or greater smoking history who quit 15 or more years ago (former heavy smokers) or for current smokers with a smoking history of 20 pack-years or less (current non-heavy smokers). The reasons for excluding these two groups is not clear but presumably is related to an expected lower lung cancer risk.
But how valid is this recommended exclusion? This was the basis for the present study in which researchers sought to examine the level of cancer risk among these two groups for whom screening is not recommended.
The researchers used patient data from the Cardiovascular Health Study which enrolled nearly 6,000 community-dwelling older adults (65 years and older) although their analysis was restricted to individuals who were free of cancer at enrolment and for whom pack-year smoking history and smoking cessation data were available. The main outcome of interest was incident lung cancer during follow-up.
Lung cancer risk over time
A total of 4279 participants with a mean age of 72.8 years (57.3% female) were included and followed for a median of 13.3 years. There were 861 current non-heavy smokers and 615 former heavy smokers and 1,973 never smokers who were used as the reference point.
During follow-up, lung cancer occurred in 0.5% of never smokers, 5% of current non-heavy smokers and 5% of former heavy smokers.
The age-adjusted hazard ratio (HR) for incident lung cancer for current non-heavy smokers was 10.06 (95% CI 3.41 – 29.70) and 10.22 (95% CI 4.86 – 21.50) for former heavy smokers, i.e., the two groups for whom screening is not recommended. The mortality risk for current, non-heavy smokers was 53% higher (HR = 1.53, 95% CI 1.22 – 1.92) and 18% higher (HR = 1.18, 95% CI 1.05 – 1.32) for former heavy smokers.
The authors concluded that there appears to be a very high lung cancer risk among those who are excluded from the recommendations for CT screening and called for future studies to examine whether annual screening could reduce lung cancer mortality in these populations.
Citation
Faselis C et al. Assessment of Lung Cancer Risk Among Smokers for Whom Annual Screening Is Not Recommended JAMA Oncol 2022
13th January 2022
Using a standalone artificial intelligence (AI) reader for lung cancer screening with ultra low-dose computed tomography (ULDCT) could potentially reduce the workload of radiologists by over 80%. This was the conclusion of a study by a team from the Department of Epidemiology, University of Groningen, Groningen, The Netherlands.
Lung cancer was responsible for 2.21 million cases and 1.8 million deaths in 2020 and volume-based, low-dose CT screening of high-risk patients has been shown to significantly reduce lung-cancer mortality compared to those who underwent no screening. Moreover, low-dose CT lung cancer screening has become an evidence-based reality.
However, the introduction of such screening will undoubtedly create an enormous increase in the workload of radiologists and while the use of a standalone AI as a second reader for lung cancer screening with CT has shown much promise, how well an AI system could perform as a standalone system remains uncertain.
For the present study, the Dutch researchers, sought to evaluate the performance of a standalone AI as an impartial reader in ULDCT lung cancer baseline screening compared to that of experienced radiologists and a consensus read reference standard.
They used a dataset of CT scans from participants who underwent a baseline scan and who were found to have at least one solid nodule of any size in their scan. Other inclusion criteria for the study were: participants aged 50 – 80 years, > 30 pack-years smoking history, current or former smoker and those who did not develop lung cancer within two years of their baseline scan.
All of the participant’s scans were independently analysed by five thoracic radiologists and the standalone AI then independently analysed all the scans to detect, measure and classify nodules. In addition, an independent consensus read was performed by a panel of three, experienced radiologists and who sought to determine the number of positive misclassifications (PM) and negative misclassifications (NM).
A PM was classified as nodules > 100 cubic mms and NM < 100 cubic mms. The results from the 5 radiologist reader and the standalone AI were compared to the consensus read to determine the number of PM and NM results as well as the number of discrepancies.
Findings
A total of 283 participants with a mean age of 64.6 years (56.9% male) with a total of 1149 lung nodules were analysed.
The consensus read was 83 PMs and 200 NMs and the standalone AI had 61 discrepancies (53 PM and 8 NM) compared to a total of 43, 36, 29, 28 and 50 from the five respective radiologists. From these results, the authors calculated that when using a standalone AI as the main reader for general lung cancer screening, there would be a workload reduction of between 77.4% and 86.7%.
The authors concluded that a standalone AI could significantly reduce the workload of radiologists in lung cancer screening.
Citation
Lancaster HL et al. Outstanding negative prediction performance of solid pulmonary nodule volume AI for ultra-LDCT baseline lung cancer screening risk stratification. Lung Cancer 2022.
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