UK Lung Cancer RCT Pilot Screening Trial: baseline findings from the screening arm provide evidence for the potential implementation of lung cancer screening

BackgroundLung cancer screening using low-dose CT (LDCT) was shown to reduce lung cancer mortality by 20% in the National Lung Screening Trial.MethodsThe pilot UK Lung Cancer Screening (UKLS) is a randomised controlled trial of LDCT screening for lung cancer versus usual care. A population-based que...

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Published in:Thorax 2016-02, Vol.71 (2), p.161-170
Main Authors: Field, J K, Duffy, S W, Baldwin, D R, Whynes, D K, Devaraj, A, Brain, K E, Eisen, T, Gosney, J, Green, B A, Holemans, J A, Kavanagh, T, Kerr, K M, Ledson, M, Lifford, K J, McRonald, F E, Nair, A, Page, R D, Parmar, M K B, Rassl, D M, Rintoul, R C, Screaton, N J, Wald, N J, Weller, D, Williamson, P R, Yadegarfar, G, Hansell, D M
Format: Article
Language:English
Subjects:
Aged
Early Detection of Cancer - methods
Female
Humans
Lung Cancer
Lung Neoplasms - diagnosis
Lung Neoplasms - epidemiology
Male
Mass Screening - methods
Middle Aged
Pilot Projects
Prevalence
Prognosis
Reproducibility of Results
Surveys and Questionnaires
Tomography, X-Ray Computed - methods
United Kingdom - epidemiology
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Summary:BackgroundLung cancer screening using low-dose CT (LDCT) was shown to reduce lung cancer mortality by 20% in the National Lung Screening Trial.MethodsThe pilot UK Lung Cancer Screening (UKLS) is a randomised controlled trial of LDCT screening for lung cancer versus usual care. A population-based questionnaire was used to identify high-risk individuals. CT screen-detected nodules were managed by a pre-specified protocol. Cost effectiveness was modelled with reference to the National Lung Cancer Screening Trial mortality reduction.Results247 354 individuals aged 50–75 years were approached; 30.7% expressed an interest, 8729 (11.5%) were eligible and 4055 were randomised, 2028 into the CT arm (1994 underwent a CT). Forty-two participants (2.1%) had confirmed lung cancer, 34 (1.7%) at baseline and 8 (0.4%) at the 12-month scan. 28/42 (66.7%) had stage I disease, 36/42 (85.7%) had stage I or II disease. 35/42 (83.3%) had surgical resection. 536 subjects had nodules greater than 50 mm3 or 5 mm diameter and 41/536 were found to have lung cancer. One further cancer was detected by follow-up of nodules between 15 and 50 mm3 at 12 months. The baseline estimate for the incremental cost-effectiveness ratio of once-only CT screening, under the UKLS protocol, was £8466 per quality adjusted life year gained (CI £5542 to £12 569).ConclusionsThe UKLS pilot trial demonstrated that it is possible to detect lung cancer at an early stage and deliver potentially curative treatment in over 80% of cases. Health economic analysis suggests that the intervention would be cost effective—this needs to be confirmed using data on observed lung cancer mortality reduction.Trial registrationISRCTN 78513845.
ISSN:0040-6376
1468-3296
DOI:10.1136/thoraxjnl-2015-207140