Why we need a lung cancer screening programme announcement – urgently.

Lung cancer is a rapidly fatal disease and therefore early diagnosis is vital. 

Earlier this year, like many other organisations in the lung cancer space, the UKLCC submitted comments to the National Screening Committee’s consultation on targeted screening for lung cancer in people aged 55 – 74 with a history of smoking.   We understand that the decision is currently with Government ministers and very much hope for an announcement as soon as possible.

Hundreds (potentially thousands) of lives have potentially been lost since the implementation of lung cancer screening was first mooted in the UK.  And according to the recent Health Select Committee Inquiry into Cancer Services, the Government has dismally failed in its target of diagnosing 75% of all cancers at stage I and II.  As the biggest cancer killer, and third most common cancer, unless we diagnose lung cancer early, this ambition will never be achieved.

If screening is approved, it is essential that a lung cancer screening programme is backed up by a robust, accurate, standardised reporting system – based on a limited number of quality measures.

It will also be important to ensure that an end-to-end service is commissioned handling everything from initial identification of participants through to hand over to local lung cancer teams for abnormal findings.  The UKLCC would also like to see a national multi-disciplinary steering committee to oversee the programme.

While there may be uniformity in many aspects of the service, there will need to be flexibility built in so that we consider local population and service needs.  Designing an appropriate service can help to secure attendance from more people in lower socioeconomic groups as well as those in rural areas. For example, using mobile screening units, can help address physical, logistical, and financial barriers to screening, such as by reducing the cost of transport and the need to take time off work to participate. The recent lung health checks pilots, situated in easy to reach locations across the country, demonstrated an increase in the number of early lung cancers diagnosed.

Indeed, recruitment of high-risk individuals is key to a successful programme. Research indicates that lung cancer screening could be an important driver for reducing health inequalities e.g., a reduction in all-cause mortality among black individuals.  In addition, there is evidence from some screening trials that women may benefit more than men from lung cancer screening.

UK wide lung cancer screening also offers the opportunity for research and data collection.  For instance, the iDX study is working with sites in Southampton and Leeds to study biomarkers in participants in the programme and the DART study out of Oxford is looking at deep learning for image analysis using artificial intelligence.

One of the biggest challenges to a national screening programme will lie around workforce to deliver the programme and meet the demand of performing and reporting extra CT scans.  This is a critically important issue underpinning deployment of a successful screening programme.  A recent Health and Social Care report estimated that on an FTE basis, the NHS is short of nearly 1,939 radiologists. 

The success of a lung cancer screening programme will be further extended by combining it with other public health initiatives, such as smoking cessation. However, while smoking is a major risk factor, we need to acknowledge other risk factors and recognise the growing number of non-smoking lung cancers which are often diagnosed at a late stage.

We hope to hear a positive outcome from Government imminently as implementation of lung cancer screening in the UK is long overdue. We strongly believe that the implementation and roll-out of a national lung cancer screening programme will do more to improve survival in lung cancer than any other single intervention.