Background COPD is a major cause of morbidity and mortality in populations eligible for lung cancer screening. We investigated the role of spirometry in a community-based lung cancer screening programme.
Methods Ever smokers, age 55–74, resident in three deprived areas of Manchester were invited to a ‘Lung Health Check’ (LHC) based in convenient community locations. Spirometry was incorporated into the LHCs alongside lung cancer risk estimation (Prostate, Lung, Colorectal and Ovarian Study Risk Prediction Model, 2012 version (PLCOM2012)), symptom assessment and smoking cessation advice. Those at high risk of lung cancer (PLCOM2012 ≥1.51%) were eligible for annual low-dose CT screening over two screening rounds. Airflow obstruction was defined as FEV1/FVC<0.7. Primary care databases were searched for any prior diagnosis of COPD.
Results 99.4% (n=2525) of LHC attendees successfully performed spirometry; mean age was 64.1±5.5, 51% were women, 35% were current smokers. 37.4% (n=944) had airflow obstruction of which 49.7% (n=469) had no previous diagnosis of COPD. 53.3% of those without a prior diagnosis were symptomatic (n=250/469). After multivariate analysis, the detection of airflow obstruction without a prior COPD diagnosis was associated with male sex (adjOR 1.84, 95% CI 1.37 to 2.47; p<0.0001), younger age (p=0.015), lower smoking duration (p<0.0001), fewer cigarettes per day (p=0.035), higher FEV1/FVC ratio (<0.0001) and being asymptomatic (adjOR 4.19, 95% CI 2.95 to 5.95; p<0.0001). The likelihood of screen detected lung cancer was significantly greater in those with evidence of airflow obstruction who had a previous diagnosis of COPD (adjOR 2.80, 95% CI 1.60 to 8.42; p=0.002).
Conclusions Incorporating spirometry into a community-based targeted lung cancer screening programme is feasible and identifies a significant number of individuals with airflow obstruction who do not have a prior diagnosis of COPD.
- lung cancer
- COPD epidemiology
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Contributors Service concept: RB, PAC, PVB and JT. Service development by members of the Macmillan Cancer Improvement Partnership: RB, PAC, PVB, JT, DC, PE and ST. Service operation and delivery by the Manchester University NHS Foundation Trust lung cancer team: HB, ME, RB, PAC and AS. Radiology reporting by the radiology consortium: RD, MG, JH, KI, DK, SM, TN, RS, AS, ES, BT, AW and JW. Data collection, analysis and drafting of manuscript: HB, JH, JV, RB and PAC. Guarantors of overall content: HB, RB and PAC. Review, revision and agreement of final manuscript: all authors.
Funding This study was funded by Macmillan Cancer Improvement Partnership.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Clinical data from the screening service were recorded on an ethically approved database (REC Ref: 16/NW/0013). North West-Greater Manchester West Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.