The UK Lung Screen (UKLS): Demographic Profile of First 88,897 Approaches Provides Recommendations for Population Screening

Abstract

The UK Lung Cancer Screening trial (UKLS) aims to evaluate low-dose computed tomography (LDCT) lung cancer population screening in the United Kingdom. In UKLS, a large population sample ages 50 to 75 years is approached with a questionnaire to determine lung cancer risk. Those with an estimated risk of at least 5% of developing lung cancer in the next 5 years (using the Liverpool Lung project risk model) are invited to participate in the trial. Here, we present demographic, risk, and response rate data from the first 88,897 individuals approached. Of note, 23,794 individuals (26.8% of all approached) responded positively to the initial questionnaire; 12% of these were high risk. Higher socioeconomic status correlated positively with response, but inversely with risk (P < 0.001). The 50-to 55-year age group was least likely to participate, and at lowest cancer risk. Only 5% of clinic attendees were ages 60 years (compared with 47% of all 88,897 approached); this has implications for cost effectiveness. Among positive responders, there were more ex-smokers than expected from population figures (40% vs. 33%), and fewer current smokers (14% vs. 17.5%). Of note, 32.7% of current smokers and 18.4% of ex-smokers were designated as high risk. Overall, 1,452 of 23,794 positive responders (6.1%) were deemed high risk and attended a recruitment clinic. UKLS is the first LDCT population screening trial, selecting high-risk subjects using a validated individual risk prediction model. Key findings: (i) better recruitment from ex-rather than current smokers, (ii) few clinic attendees ages early 50s, and (iii) representative number of socioeconomically deprived people recruited, despite lower response rates. Cancer Prev Res; 7(3); 362-71. Ó2014 AACR.

The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer

“…93 In the first 88,897 individuals approached to take part in UKLS, participation was more likely in ex-smokers and those in higher socioeconomic groups. 94 Other barriers may include fears about lung screening tests and radiation exposure, and fatalistic beliefs about lung cancer. 95,96 Psychosocial impact of lung screening trial allocation…”

“…Use of volumetry will reduce the need for further imaging and better predictions of malignancy will reduce the number of minimally invasive and invasive tests combination of factors (such as previous respiratory disease, previous cancer, family history of lung cancer and exposure to asbestos) in addition to smoking duration and age (as used in the UKLS). 23,94 A number of these risk parameters are readily obtainable in a general practice setting. 149 The utilisation of a risk prediction model to refine the selection process can also be successfully undertaken by an agency such as Radar, who worked very successfully with the UKLS.…”

“…There is a clinical need to ensure the acceptability of CT lung screening to those at higher risk, such as long-term smokers, and a public health imperative to ensure we put measures in place to include the 'hard to reach' groups that have the highest rates of lung cancer, and to understand the barriers to participating in lung cancer screening. The UKLS team have previously reported that participation was more likely in ex-smokers and those with a higher socioeconomic status 94 in the first 88,897 individuals who were approached to take part in the UKLS.…”

Bronchialkarzinomscreening – Risikostratifizierung

“…org verfügbar. In die noch laufende UKLS-Studie werden nur jene Personen eingeschlossen, die basierend auf dem LLPv2-Modell ein ≥5 %iges Risiko aufweisen, in den kommenden 5 Jahren ein Bronchialkarzinom zu entwickeln [15].…”

Risk prediction models in lung cancer: The methodology for identifying high risk individuals for future lung cancer computed tomography (CT) screening programs

“…The LLP v2 risk model (18) has been used to select high-risk individual in the United Kingdom Lung Screening (UKLS) (14). UKLS is a randomized, controlled trial of LDCT for lung cancer screening, following the Wald single-screen design.…”