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Lung cancer
Original article
UK Lung Cancer RCT Pilot Screening Trial: baseline findings from the screening arm provide evidence for the potential implementation of lung cancer screening
  1. J K Field1,
  2. S W Duffy2,
  3. D R Baldwin3,
  4. D K Whynes4,
  5. A Devaraj5,
  6. K E Brain6,
  7. T Eisen7,
  8. J Gosney8,
  9. B A Green1,
  10. J A Holemans9,
  11. T Kavanagh10,
  12. K M Kerr11,
  13. M Ledson9,
  14. K J Lifford6,
  15. F E McRonald1,
  16. A Nair12,
  17. R D Page9,
  18. M K B Parmar13,
  19. D M Rassl14,
  20. R C Rintoul14,
  21. N J Screaton14,
  22. N J Wald2,
  23. D Weller15,
  24. P R Williamson1,
  25. G Yadegarfar1,
  26. D M Hansell5
  1. 1Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
  2. 2Queen Mary University of London, London, UK
  3. 3Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
  4. 4School of Economics, University of Nottingham, Nottingham, UK
  5. 5Royal Brompton and Harefield NHS Foundation Trust, London, UK
  6. 6Cardiff University School of Medicine, Cardiff, UK
  7. 7University of Cambridge, Cambridge Biomedical Research Centre, Cambridge, UK
  8. 8Department of Pathology, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, UK
  9. 9Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool UK
  10. 10Lung Cancer Patient Advocate, Liverpool, UK
  11. 11Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, UK
  12. 12Guy's and St Thomas’ NHS Foundation Trust, London, UK
  13. 13Medical Research Council Clinical Trials Unit at UCL, London, UK
  14. 14Department of Histopathology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
  15. 15Center for Population Health Sciences, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Professor John K Field, Roy Castle Lung Cancer Research Programme, University of Liverpool, The Apex Building, 6 West Derby Street, Liverpool L7 8TX, UK; j.k.field{at}liv.ac.uk

Abstract

Background Lung cancer screening using low-dose CT (LDCT) was shown to reduce lung cancer mortality by 20% in the National Lung Screening Trial.

Methods The pilot UK Lung Cancer Screening (UKLS) is a randomised controlled trial of LDCT screening for lung cancer versus usual care. A population-based questionnaire was used to identify high-risk individuals. CT screen-detected nodules were managed by a pre-specified protocol. Cost effectiveness was modelled with reference to the National Lung Cancer Screening Trial mortality reduction.

Results 247 354 individuals aged 50–75 years were approached; 30.7% expressed an interest, 8729 (11.5%) were eligible and 4055 were randomised, 2028 into the CT arm (1994 underwent a CT). Forty-two participants (2.1%) had confirmed lung cancer, 34 (1.7%) at baseline and 8 (0.4%) at the 12-month scan. 28/42 (66.7%) had stage I disease, 36/42 (85.7%) had stage I or II disease. 35/42 (83.3%) had surgical resection. 536 subjects had nodules greater than 50 mm3 or 5 mm diameter and 41/536 were found to have lung cancer. One further cancer was detected by follow-up of nodules between 15 and 50 mm3 at 12 months. The baseline estimate for the incremental cost-effectiveness ratio of once-only CT screening, under the UKLS protocol, was £8466 per quality adjusted life year gained (CI £5542 to £12 569).

Conclusions The UKLS pilot trial demonstrated that it is possible to detect lung cancer at an early stage and deliver potentially curative treatment in over 80% of cases. Health economic analysis suggests that the intervention would be cost effective—this needs to be confirmed using data on observed lung cancer mortality reduction.

Trial registration ISRCTN 78513845.

  • Lung Cancer
  • Imaging/CT MRI etc

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/thoraxjnl-2015-207140

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