Invitation strategies and participation in a community-based lung cancer screening programme located in areas of high socioeconomic deprivation

Abstract

IntroductionAlthough lung cancer screening is being implemented in the UK, there is uncertainty about the optimal invitation strategy. Here, we report participation in a community screening programme following a population-based invitation approach, examine factors associated with participation, and compare outcomes with hypothetical targeted invitations.MethodsLetters were sent to all individuals (age 55–80) registered with a general practice (n=35 practices) in North and East Manchester, inviting ever-smokers to attend a Lung Health Check (LHC). Attendees at higher risk (PLCOm2012NoRacescore≥1.5%) were offered two rounds of annual low-dose CT screening. Primary care recorded smoking codes (live and historical) were used to model hypothetical targeted invitation approaches for comparison.ResultsLetters were sent to 35 899 individuals, 71% from the most socioeconomically deprived quintile. Estimated response rate in ever-smokers was 49%; a lower response rate was associated with younger age, male sex, and primary care recorded current smoking status (adjOR 0.55 (95% CI 0.52 to 0.58), p<0.001). 83% of eligible respondents attended an LHC (n=8887/10 708). 51% were eligible for screening (n=4540/8887) of whom 98% had a baseline scan (n=4468/4540). Screening adherence was 83% (n=3488/4199) and lung cancer detection 3.2% (n=144) over 2 rounds. Modelled targeted approaches required 32%–48% fewer invitations, identified 94.6%–99.3% individuals eligible for screening, and included 97.1%–98.6% of screen-detected lung cancers.DiscussionUsing a population-based invitation strategy, in an area of high socioeconomic deprivation, is effective and may increase screening accessibility. Due to limitations in primary care records, targeted approaches should incorporate historical smoking codes and individuals with absent smoking records.

The Smokers Health Multiple ACtions (SMAC-1) Trial: Study Design and Results of the Baseline Round

“…There are three types of recruitments for screening: active, where a high-risk subject is identified with the goal to set a first appointment; voluntary, where the subject reaches out to the screening program autonomously; and GP based. An implementation to active recruitment can be found in the Targeted Lung Health Check (TLHC) program, where effective communication reduced the risk of community stigmatization and mobile scanners were used close to social facilities [60][61][62][63]. Regarding the SMAC-1 recruitment phase, 67% of eligible subjects joined the screening.…”

Smoking data quality of primary care practices in comparison with smoking data from the New Zealand Māori and Pacific abdominal aortic aneurysm screening programme: an observational study

“…A US study found that 54.5% of patients had implausible changes in their smoking status, such as current smoker to never smoker [ 64 ]. A recent large UK study found that individuals with missing smoking data in PCP were more likely to have a history of smoking [ 65 ]. Programmes that include PCP based eligibility criteria should consider ways to inform those recorded as non-smokers or those with missing records about the programme, and invite them to contact the programme via low cost mechanisms such as text messaging, electronic portal notification, or letters; notifying potentially eligible patients of the programme and smoking eligibility criteria, and that if they believe their data is incorrectly recorded or that they may be eligible (e.g.…”

“…Programmes that include PCP based eligibility criteria should consider ways to inform those recorded as non-smokers or those with missing records about the programme, and invite them to contact the programme via low cost mechanisms such as text messaging, electronic portal notification, or letters; notifying potentially eligible patients of the programme and smoking eligibility criteria, and that if they believe their data is incorrectly recorded or that they may be eligible (e.g. for lung cancer screening or AAA screening) [ 65 , 66 ]. Studies have observed the unreliability of self-reported smoking status and looked at ways to tackle the underestimation of true smoking using objective measurements of smoking exposure, such as measurements of blood or urinary biomarkers [ 23 , 67 – 71 ].…”