We report baseline results of a community-based, targeted, low-dose CT (LDCT) lung cancer screening pilot in deprived areas of Manchester. Ever smokers, aged 55-74 years, were invited to 'lung health checks' (LHCs) next to local shopping centres, with immediate access to LDCT for those at high risk (6-year risk ≥1.51%, PLCO calculator). 75% of attendees (n=1893/2541) were ranked in the lowest deprivation quintile; 56% were high risk and of 1384 individuals screened, 3% (95% CI 2.3% to 4.1%) had lung cancer (80% early stage) of whom 65% had surgical resection. Taking lung cancer screening into communities, with an LHC approach, is effective and engages populations in deprived areas.

Animal olfactory detection of human diseases has attracted an increasing amount of interest from researchers in recent years. Because of the inconsistent findings reported in this body of research and the complexity of scent detection research, it is difficult to ascertain the potential value of animal detectors in operational diagnostic algorithms. We have outlined key factors associated with successful training and evaluation of animals for operational disease detection and, using these key factors as points for comparison, conducted a systematic review of the research in this area. Studies that were published in peer-reviewed outlets and that described original research evaluating animals for detection of human diseases were included in the review. The majority of relevant studies have assessed dogs as detectors of various forms of cancer. Other researchers have targeted bacteriuria, Clostridium difficile, hypoglycemia, and tuberculosis. Nematodes and pouched rats were the only exceptions to canine detectors. Of the 28 studies meeting inclusion criteria, only 9 employed operationally feasible procedures. The most common threat to operational viability was the use of a fixed number of positive samples in each sample run. Most reports included insufficient information for replication or adequate evaluation of the validity of the findings. Therefore, we have made recommendations regarding the type of information that should be included when describing research in this area. The results of this systematic review suggest that animal detectors hold promise for certain diagnostic applications but that additional research evaluating operationally viable systems for olfactory detection of human diseases is necessary.

Michigan University. We are grateful for the helpful input of Caio Miguel on an earlier version of this manuscript and the many researchers and practitioners with whom we have discussed these ideas.

We report results from the second annual screening round (T1) of Manchester’s ‘Lung Health Check’ pilot of community-based lung cancer screening in deprived areas (undertaken June to August 2017). Screening adherence was 90% (n=1194/1323): 92% of CT scans were classified negative, 6% indeterminate and 2.5% positive; there were no interval cancers. Lung cancer incidence was 1.6% (n=19), 79% stage I, treatments included surgery (42%, n=9), stereotactic ablative radiotherapy (26%, n=5) and radical radiotherapy (5%, n=1). False-positive rate was 34.5% (n=10/29), representing 0.8% of T1 participants (n=10/1194). Targeted community-based lung cancer screening promotes high screening adherence and detects high rates of early stage lung cancer.