The effect of direct access to CT scan in early lung cancer detection: an unblinded, cluster-randomised trial

Abstract

BackgroundLower lung cancer survival rates in Britain and Denmark compared with surrounding countries may, in part, be due to late diagnosis. The aim of this study was to evaluate the effect of direct access to low-dose computed tomography (LDCT) from general practice in early lung cancer detection on time to diagnosis and stage at diagnosis.MethodsWe conducted a cluster-randomised, controlled trial including all incident lung cancer patients (in 19-month period) listed with general practice in the municipality of Aarhus (300,000 citizens), Denmark. Randomisation and intervention were applied at general practice level. A total of 266 GPs from 119 general practices. In the study period, 331 lung cancer patients were included. The intervention included direct access to low-dose CT from primary care combined with a 1 h lung cancer update meeting. Indication for LDCT was symptoms or signs that raised the GP’s suspicion of lung cancer, but fell short of satisfying the fast-track referral criteria on red flag’ symptoms. ResultsThe intervention did not significantly influence stage at diagnosis and had limited impact on time to diagnosis. However, when correcting for non-compliance, we found that the patients were at higher risk of experiencing a long diagnostic interval if their GPs were in the control group.ConclusionDirect low-dose CT from primary care did not statistically significantly decrease time to diagnosis or change stage at diagnosis in lung cancer patients. Case finding with direct access to LDCT may be an alternative to lung cancer screening. Furthermore, a recommendation of low-dose CT screening should consider offering symptomatic, unscreened patients an access to CT directly from primary care.Trial registrationwww.clinicaltrials.gov, registration ID number NCT01527214.

Genistein decreases A549 cell viability via inhibition of the PI3K/AKT/HIF-1α/VEGF and NF-κB/COX-2 signaling pathways

“…Despite advances in surgical, radiotherapeutic and chemotherapeutic strategies, lung cancer is an aggressive and heterogeneous disease, and therefore the long-term survival rate remains low (5)(6)(7). Lung cancer treatment is complex for numerous reasons, including hard-to-detect early symptoms, early metastasis and vascular factors that mediate drug-resistance and disease progression (8)(9)(10). Previous studies have investigated inhibiting angiogenesis and antagonizing vascular endothelial growth factors as potential therapeutic targets for the treatment of lung cancer (11,12); however, the potential of this strategy remains unclear.…”

Directing the senses in the contemporary orientations to cancer disease control: Debating symptom research

“…Lastly, I outlined an anthropology of sensations as a framework for understanding symptoms as cultural configurations and briefly illustrated its utility for exploring more overall relations between biomedical knowledge production and everyday, embodied experience and the building of contemporary forms of disease sensitisation. of those given the option of a CT scan) is encouraged to do follow-up scans for up to two years after their initial diagnostic investigation (Guldbrandt et al, 2015). 7 Conversations on human sense-modals date back to Aristotle and his presentation of the five-sense-modal.…”

“…Computerised tomography (CT) scanners and access to digital imaging technologies have, for example, altered diagnostic potential for lung cancers in Denmark (Guldbrandt et al, 2015), and the introduction of capsule endoscopy is expected to lead to ear- …”

Immediate chest X-ray for patients at risk of lung cancer presenting in primary care: randomised controlled feasibility trial

“…There is an emerging literature regarding allowing GPs access to low-dose CT, for patients with symptoms where lung cancer is suspected ( Guldbrandt et al , 2014 ). However, a recent cluster trial in Denmark reported little improvement in stage or times to diagnosis with direct access to CT ( Gulbrandt et al , 2015 ). This trial had different inclusion criteria to our design, hence it is unknown what effect on outcomes an individually randomised trial of direct access to CT for ‘extra-NICE' symptoms would be.…”