Baseline Results of the West London lung cancer screening pilot study – Impact of mobile scanners and dual risk model utilisation

Randomised clinical trials have shown the efficacy of computed tomography lung cancer screening, initiating discussions on whether and how to implement population-based screening programs. Due to smoking behaviour being the primary risk-factor for lung cancer and part of the criteria for determining screening eligibility, lung cancer screening is inherently risk-based. In fact, the selection of high-risk individuals has been shown to be essential in implementing lung cancer screening in a cost-effective manner. Furthermore, studies have shown that further riskstratification may improve screening efficiency, allow personalisation of the screening interval and reduce health disparities. However, implementing risk-based lung cancer screening programs also requires overcoming a number of challenges. There are indications that risk-based approaches can negatively influence the trade-off between individual benefits and harms if not applied thoughtfully. Large-scale implementation of targeted, risk-based screening programs has been limited thus far. Consequently, questions remain on how to efficiently identify and invite high-risk individuals from the general population. Finally, while risk-based approaches may increase screening program efficiency, efficiency should be balanced with the overall impact of the screening program. In this review, we will address the opportunities and challenges in applying risk-stratification in different aspects of lung cancer screening programs, as well as the balance between screening program efficiency and impact. K E Y W O R D S lung cancer screening, personalised screening, risk-based screening Abbreviations: 4-IN-THE-LUNG-RUN, (Towards INdividually tailored INvitations screening INtervals and INtegrated co-morbidity reducing strategies in lung cancer screening) implementation trial; AUC, area under the receiver operating characteristic curve; BMI, body mass index; bioMILD, the Plasma microRNA Profiling as First Line Screening Test for Lung Cancer Detection: a

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“…West London Screening Pilot: 1.51% risk‐threshold 166 …”

Section: Identification Of Individuals Eligible For Screening Through Risk‐prediction Modelsmentioning

confidence: 99%

Personalising lung cancer screening: An overview of risk‐stratification opportunities and challenges

Haaf

Aalst

Koning

et al. 2021

Intl Journal of Cancer

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“…Of 8366 subjects invited for a LHC, 1542 attended a LHC appointment, had a clinical consultation and a risk score calculation 11 . Spirometry was performed on 1532/1542 participants (99.4%); 1145/1542 (74.2%) had a LDCT scan.…”

Section: Resultsmentioning

confidence: 99%

“…A targeted LCS pilot study commenced in West London in August 2018, the baseline results of which have been previously published 11 . The aims of this sub-study were to evaluate the impact of identification of incidental findings from LHCs and targeted lung screening on primary care and screening participants.…”

Section: Introductionmentioning

confidence: 99%

Implications of incidental findings from lung screening for primary care: data from a UK pilot

Bartlett

Belsey²,

Derbyshire

et al. 2021

npj Prim. Care Respir. Med.

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Regional lung cancer screening (LCS) is underway in England, involving a “lung health check” (LHC) and low-dose CT scan for those at high risk of cancer. Incidental findings from LHCs or CTs are usually referred to primary care. We describe the proportion of participants referred from the West London LCS pilot to primary care, the indications for referral, the number of general practitioner (GP) attendances and consequent changes to patient management, and provide an estimated cost-burden analysis for primary care. A small proportion (163/1542, 10.6%) of LHC attendees were referred to primary care, primarily for suspected undiagnosed chronic obstructive pulmonary disease (55/163, 33.7%) or for QRISK® (63/163, 38.7%) assessment. Ninety one of 159 (57.2%) participants consenting to follow-up attended GP appointments; costs incurred by primary care were estimated at £5.69/LHC participant. Patient management changes occurred in only 36/159 (22.6%) referred participants. LHCs result in a small increase to primary care workload provided a strict referral protocol is adhered to. Changes to patient management arising from incidental findings referrals are infrequent.

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“…To overcome such a limitation, the Manchester Lung Health Check program (a pilot community-based study) used mobile CT scanners placed outside shopping centers, with the purpose of providing access to LCS for high-risk subjects from the most deprived areas of Manchester [31]. Yet, the Western London trial recently showed that the screening participants did not prefer a mobile site over a fixed site, especially if the fixed site is located within an efficient commutation network [32]. Therefore, the optimal format of LCS should be specifically designed according to the target region.…”

Section: Introductionmentioning

confidence: 99%

Lung Cancer Screening: Evidence, Risks, and Opportunities for Implementation

Tringali

Milanese

Ledda

et al. 2021

Rofo

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Background Lung cancer is the most common cause of cancer death worldwide. Several trials with different screening approaches have recognized the role of lung cancer screening with low-dose CT for reducing lung cancer mortality. The efficacy of lung cancer screening depends on many factors and implementation is still pending in most European countries. Methods This review aims to portray current evidence on lung cancer screening with a focus on the potential for opportunities for implementation strategies. Pillars of lung cancer screening practice will be discussed according to the most updated literature (PubMed search until November 16, 2020). Results and Conclusion The NELSON trial showed reduction of lung cancer mortality, thus confirming previous results of independent European studies, notably by volume of lung nodules. Heterogeneity in patient recruitment could influence screening efficacy, hence the importance of risk models and community-based screening. Recruitment strategies develop and adapt continuously to address the specific needs of the heterogeneous population of potential participants, the most updated evidence comes from the UK. The future of lung cancer screening is a tailored approach with personalized continuous stratification of risk, aimed at reducing costs and risks. Key Points: Citation Format

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Baseline Results of the West London lung cancer screening pilot study – Impact of mobile scanners and dual risk model utilisation

Cited by 42 publications

References 18 publications

Personalising lung cancer screening: An overview of risk‐stratification opportunities and challenges

Personalising lung cancer screening: An overview of risk‐stratification opportunities and challenges

Implications of incidental findings from lung screening for primary care: data from a UK pilot

Lung Cancer Screening: Evidence, Risks, and Opportunities for Implementation

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