Introduction Lung cancer remains the leading cause of cancer related death globally. Low-dose CT (LDCT) screening of high-risk individuals reduces lung cancer specific mortality. An important requirement for any screening programme is to minimise harms, especially in those who do not have cancer. Data from randomised controlled trials is often used as the primary source from which to extrapolate risks of harm but they do not reflect modern, real-world practice. In this paper we present cumulative data on screening harms from five UK-based lung cancer screening programmes.
Methods In the UK, several implementation pilots and research studies have demonstrated that screening can be successfully delivered within or aligned to the NHS. These include: UK Lung Cancer Screening Trial (UKLS), Lung Screen Uptake Trial, Manchester Lung Health Checks, Liverpool Healthy Lung Project and Nottingham Lung Health MOT.Most sites used BTS nodule management guidelines. Positive results were defined as those referred for more than a repeat LDCT. False positives were those positive screens without an eventual diagnosis of lung cancer. Harms were categorised according to the need for further imaging, invasive investigations and/or surgery. Complications were categorised as per the National Lung Screening Trial (NLST).
Results A total of 11,815 screening LDCTs were performed across the five programmes (2016–2020). Overall, 85.5% of screening scans were categorised as negative, 10.5% as indeterminate and 4% as positive. Lung cancer detection was 2.1%, ranging from 1.7% to 4.4% across sites. The surgical resection rate was 66.0%. Details of the cumulative reported harms are summarised in table 1.
Discussion This collaborative work provides up-to-date data on lung cancer screening performance and harms. The rate of positive (4%) and false positive (1.9%) screening results were significantly lower than NLST and the majority of European screening trials. Harms from investigation and treatment of non-malignant disease was minimised with no reported major complications or deaths. This provides reassurance that with the use of evidence-based practice and experienced MDTs, harms from false positive results can be minimised within screening. This information is important in the planning of larger scale implementation of lung cancer screening within the UK and beyond.
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