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Ministers approve lung cancer screening pilots

By Lilian Anekwe

Exclusive: The NHS is to begin piloting the use of CT scans to screen patients at high risk of lung cancer, in a move which could herald a UK national screening programme, Pulse can reveal.

After a ten-year funding delay the Department of Health has finally given the go-ahead for a pilot study, the UK Lung Screen (UKLS), to begin in the coming months. It will initially cover 4,000 patients across several PCTs, and could then be extended to 28,000 patients next year.

It comes after an NHS-funded evaluation in 2009 found it would be feasible to use a trial of CT scans to screen and detect lung cancer in high risk patients, and follows the Government's launch last month of a £750m national cancer strategy which will see GPs given access to key diagnostic tests for cancer.

The randomised controlled trial will compare the cost-effectiveness, impact on mortality and possible harms of using low-dose CT or no screening for lung cancer.

According to details published online by the journal Thorax this month, the UKLS will will select patients aged between 50 and 75 years old at random from NHS records. Those classed as high risk – defined as a 5% absolute risk of developing lung cancer within five years – will be contacted to take part.

‘Using this selection criterion, it is likely that cancer will be detectable in around 1.5% of subjects at the first screen,' the researchers wrote.

The screen is designed to detect nodules within the lung, which are classified into four categories that reflect their probability of being malignant. Category 1 nodules are considered a negative finding and no further investigation will be required in patients with these abnormalities.

But patients with nodules in categories 2 and 3 will have a repeat CT at 1 year, and at 3 months and 1 year, respectively. Any nodule that has doubled in size in less than 400 days could be malignant and these patients will have further diagnostic investigations.

Dr David Baldwin, consultant in respiratory medicine at the Nottingham City hospital and lead respiratory physician for the UKLS, said: ‘We are becoming convinced now that this is the way to reduce mortality from lung cancer, and we could widen the screening population very easily.'

‘We are discussing that actively at the moment and I really do think we need to be ready for the possibility that people will say we need to be introducing a screening programme right away. There a lot of support from the DH for screening.'

Professor John Field, director of research of the Roy Castle lung cancer research programme at the University of Liverpool and principal investigator for the UK Lung Cancer Screening Trial, said: ‘The success of CT screening trials could potentially lead to the implementation of a national lung cancer programme, which could have an enormous impact. We could see significant changes in managing the disease, similar to the impact of breast screening over the last 15 years.'

CT scanner Lung cancer screening trials

November 06 – New England Journal of Medicine study found low dose CT screening flipped survival figures on their head, turning 95% death rates into survival rates of up to 90%.

May 07 – Researchers develop the Liverpool Lung Project Risk Prediction model, which uses factors such as smoking and family history, to predict absolute 5-year risk of lung cancer, and validate it in a two-year general practice-based study

October 09 – NHS Health Technology Appraisal-funded feasibility study shows a trial of lung cancer screening using CT would be possible

November 2010 – A study sponsored by the US National Cancer Institute found 20% fewer lung cancer deaths among those who were screened with low-dose CT compared with those who were screened with chest X-rays.

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