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Opinion
CT screening for lung cancer in the UK: position statement by UKLS investigators following the NLST report
  1. John Kirkpatrick Field1,
  2. David Baldwin2,
  3. Kate Brain3,
  4. Anand Devaraj4,
  5. Tim Eisen5,
  6. Stephen W Duffy6,
  7. David M Hansell7,
  8. Keith Kerr8,
  9. Richard Page9,
  10. Mahesh Parmar10,
  11. David Weller11,
  12. Paula Williamson12,
  13. David Whynes13,
  14. UKLS Team*
  1. 1Department of Molecular & Clinical Cancer Medicine, Institute of Translational Medicine, The University of Liverpool, Liverpool, UK
  2. 2Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals, Nottingham, UK
  3. 3Institute of Medical Genetics, Clinical Epidemiology Interdisciplinary Research Group, Cardiff University School of Medicine, Cardiff, UK
  4. 4Department of Radiology, St George's Hospital London, London, UK
  5. 5Cambridge Biomedical Research Centre, Cambridge, UK
  6. 6Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  7. 7Department of Radiology, Royal Brompton Hospital, London, UK
  8. 8Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, UK
  9. 9Department of Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
  10. 10Medical Research Council Clinical Trials Unit, London, UK
  11. 11Clinical Sciences and Community Health, Division of Community Health Sciences, University of Edinburgh, Edinburgh, UK
  12. 12Department of Biostatistics, University of Liverpool, Liverpool, UK
  13. 13School of Economics, University of Nottingham, Nottingham, UK
  1. Correspondence to Professor John Kirkpatrick Field, Department of Molecular & Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool L3 9TA, UK; j.k.field{at}liv.ac.uk

Abstract

Background The imminent publication of a randomised controlled trial from the USA that suggests CT screening reduces mortality from lung cancer by more than 20%, may potentially lead to one of the most important developments in lung cancer care. However, there remain important questions about the applicability of the results to the UK and the clinical effectiveness of this intervention, including its feasibility and cost-effectiveness.

Objective To describe the remaining questions that need to be answered by further research and to comment on the use of CT screening in the UK outside a clinical trial.

Methods The detailed design process of the UKLS protocol and international discussions were used to identify the research questions that remain to be answered and to inform those who may choose to consider offering CT screening, before these questions are answered.

Results A series of research imperatives have been identified and we advise that CT screening should be part of the ongoing clinical trial in the UK, currently in the pilot phase (UKLS). UKLS is randomising 4,000 individuals for the pilot and a total of 32,000 for the main study.

Conclusion There remain unresolved issues with respect to CT screening for lung cancer. These include its feasibility, psychosocial and cost-effectiveness in the UK, harmonisation of CT acquisition techniques, management of suspicious screening findings, the choice of screening frequency and the selection of an appropriate risk group for the intervention. UKLS is aimed at resolving these issues.

  • COPD epidemiology
  • lung cancer
  • non-small-cell lung cancer
  • small-cell lung cancer
  • tobacco and the lung
  • bronchiectasis
  • bronchoscopy
  • cystic fibrosis
  • lung cancer
  • imaging/CT MRI
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Footnotes

  • * UKLS Team

    Professor John K Field, (CI) University of Liverpool.

    Dr David Baldwin, Nottingham, University Hospital.

    Dr Kate Brain, Cardiff University.

    Dr Anand Devaraj, St George's Hospital, London.

    Professor Tim Eisen, University of Cambridge.

    Professor Stephen Duffy, Barts and The London.

    Professor David Hansell, Royal Brompton Hospital.

    Professor Keith Kerr, Aberdeen Royal Infirmary.

    Mr Richard Page, Liverpool Heart & Chest Hospital.

    Professor Mahesh Parmar, Medical Research Council Clinical Trial Unit, London.

    Professor David Weller, University of Edinburgh.

    Professor Paula Williamson, University of Liverpool.

    Professor David Whynes, University of Nottingham.

  • Funding The UKLS is funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA).

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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