June 22, 2023

expert reaction to NHS plan to provide a lung cancer test for every ex-smoker from middle age

The NHS has announced that people aged between 55 and 74 who have smoked may be offered an NHS lung health check.

Sarah Woolnough, CEO at Asthma + Lung UK, said:

“The rollout of Targeted Lung Health Checks to improve the diagnosis of lung cancer is an incredibly positive step forward. Lung cancer is often diagnosed late, when it’s much harder to treat, so we hope this programme will help transform lung cancer outcomes. However, these tests also have the potential to identify a wider range of lung conditions, including COPD, pulmonary fibrosis, and bronchiectasis. We’d like to see the programme take the opportunity to look in detail for these conditions and ensure people receive early treatment if they are identified. Likewise, the lung health check is a great opportunity to help people look after their lungs, by referring people to smoking cessation where appropriate, and raising the importance of maintaining good lung health.”

Prof Stephen Duffy, Professor of Cancer Screening, Wolfson Institute of Population Health, Queen Mary University of London (QMUL), said:

“The Lung Health Checks include a detailed risk assessment for lung cancer to identify those who need low dose CT screening. This is very sensitive imaging of the lungs, and its use has been shown in high-quality research to detect lung cancer at an early stage and to reduce lung cancer mortality by around 20%. Because there are downsides to screening, it is best to offer it only to those at sufficiently heightened risk of lung cancer.

“These lung health checks, coupled with low dose CT for those at high risk, have already been working well as local initiatives. The national policy will add to this.

“In addition to their potential for reducing deaths from lung cancer, the health checks can flag up other chest problems which can be dealt with, and offer support for smoking cessation, which is one of the best things a person can do for their future health.

“Therefore, this policy is likely to result in a significant reduction in numbers of lung cancer deaths, and will probably have other health benefits beyond lung cancer.”

Prof Robert Rintoul, Professor of Thoracic Oncology, University of Cambridge, said:

Comments on the strength of the evidence supporting the implementation of this policy?

“The evidence that lung cancer screening works is very strong and incontrovertible.  Two large randomised controlled trials (the US National Lung Screening Trial – NLST and the European NELSON trial) have both shown that lung cancer screening of a high-risk population (ever smokers aged 55-74) works and reduces deaths due to lung cancer. Further smaller studies were combined with follow up data from the UK Lung Screening Trial confirming this.

“Field JK, Vulkan D, Davies MPA, Baldwin DR, Brain KE, Devaraj A, Eisen T, Gosney J, Green BA, Holemans JA, Kavanagh T, Kerr KM, Ledson M, Lifford KJ, McRonald FE, Nair A, Page RD, Parmar MKB, Rassl DM, Rintoul RC, Screaton NJ, Wald NJ, Weller D, Whynes DK, Williamson PR, Yadegarfar G, Gabe R, Duffy SW. Lung cancer mortality reduction by LDCT screening: UKLS randomised trial results and international meta-analysis. Lancet Reg Health Eur. 2021 Sep 11;10:100179. doi: 10.1016/j.lanepe.2021.100179. PMID: 34806061; PMCID: PMC8589726.”

“In the UK, lung cancer screening has also been shown to be cost-effective.

“The UK National Screening Committee have made a recommendation to ministers to implement a national targeted lung cancer screening programme.

“This is currently under review and an announcement is awaited. 

“Since 2020 NHS England have started a lung health check programme involving CT scans for people at high risk age 55-74.  This is now running at 43 sites across England (Phase 1 and 2) with plans to expand to many more sites (phase 3) over the next 5 years.”

How many more people will be offered a lung cancer test as a result of this?

“Ever smokers aged 55-74 will be invited. Currently, it is thought that there are about 6M people eligible in the UK.

“The actual number involved will depend on our ability to identify appropriate individuals and then encourage them to attend an assessment.  A lot of research is being undertaken on the best way to approach and engage different groups and communities to try to minimise health inequalities (e.g. via Behavioural Insights Team).  Because it will be a rolling programme new individuals will be invited as they turn 55.”

How many more cases of lung cancer could be caught early as a result of this?

“Around 1%-1.5% of individuals identified as being at high risk are found to have lung cancer, the vast majority of which are early stage and can be offered treatment with potential curative intent. 

How does identifying a case of lung cancer earlier affect the chances of survival? How many people could this save?

“Normally around 75% of people identified with lung cancer have advanced stage disease.  Only 25% are found to have early-stage disease which can be treated with curative intent.

“However, the pilot lung health check programmes have demonstrated that 75% of the lung cancers identified, are early stage.

“Identifying and treating far more patients with early-stage disease will save many thousands of lives every year.”

Any other comments on this policy?

“Establishing a national lung cancer screening programme across the UK would be transformative for lung cancer care saving many thousands of lives every year. Modelling work has shown that screening the 55-74 age group is most cost-effective.

“One big unsolved challenge is how to help never smokers who are at risk of lung cancer.  Around 15% of lung cancer cases in the UK are never smokers.  Under the current proposals never smokers are not included in the plan.  The challenge is how to identify never smokers at highest risk for lung cancer so that we do not scan many people who do not need a scan.  A lot of research is starting to look at this group of individuals.” 

https://www.nhs.uk/conditions/lung-health-checks/

Declared interests

Prof Stephen Duffy: “I have no conflict of interest to declare.”

Prof Robert Rintoul: “I am the Chair of the Clinical Advisory Group of the UK Lung Cancer Coalition (UKLCC)

I am a co-author on the UK Lung Screening Trial (UKLS)

I am a member of the Roy Castle Lung Cancer Clinical Expert Group.”

For all other experts, no reply to our request for DOIs was received.