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There has been almost a 1000 ‘lung cancer screening’ papers and abstracts over the past 10 years, with half published in the last two. Avoiding the topic of lung cancer screening at respiratory, radiology and oncology conferences is becoming increasingly challenging. Is it realistic that we are going to screen for lung cancer in the UK?
We know, despite our continued efforts, that the UK health system serves its patients with lung cancer poorly. Current UK lung cancer statistics demonstrate a 13% 5-year survival attributed largely to late-stage presentation.1 Approximately 70% of lung cancer is diagnosed at stage III and IV where options for curative treatment are greatly diminished.2 There can be no doubt, therefore, that earlier diagnosis is crucial to improving lung cancer outcomes, and nowhere more so than the UK. However, the data supporting low radiation dose CT screening (LDCT) for lung cancer are from the USA where medicine is practised rather differently and resources not so limited. So, until this issue of Thorax, there has been a paucity of evidence from Britain to support the extrapolation of available data to our patients. The UK Lung Cancer Pilot Screening Trial (UKLS) reports the findings of its Wald single screen design randomised controlled pilot providing data that address many questions, but raise others.3
The first issue is that of determining eligibility for screening. One can reduce patient eligibility by increasing the risk threshold required to screen, thereby enriching the lung …