A pilot lung cancer screening trial, conducted by health experts from the University of Liverpool, has demonstrated that it is possible to detect lung cancer at an early stage and deliver a potentially curative treatment in over 80% of cases.
The UK Lung Cancer Screening trial (UKLS) was undertaken in partnership with Liverpool Heart & Chest Hospital, Papworth Hospital and the Royal Brompton Hospital with the aim of highlighting the need for a screening programme to help benefit people who are at risk of developing lung cancer.
Lung cancer kills more people than any other cancer. The number of deaths in 2012 in the UK was 35,370, making lung cancer the commonest cause of cancer death in the UK for both men and women.
Identifying those at risk
One of the main reasons why lung cancer outcomes are so poor is that approximately 70% of patients first present to specialist care with incurable advanced disease and current treatment at this late stage has very little effect on mortality.
If a patient’s lung cancer is identified at an early stage, however, then the clinical outcome is greatly improved. Individuals with very early stage disease have up to a 73% chance of surviving for five years or more. As a result there is a major national and international focus on CT screening trials.
Funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme the trial was the first and only lung cancer screening trial to take place in the UK and has provided indepth information on how to set up a national lung cancer CT screening programme, including using a risk prediction model to identify high risk individuals in the population.
UKLS is a randomised controlled trial of lung cancer screening versus usual care in 4,055 individuals that used a population-based questionnaire to identify high-risk individuals. The screening used a low dose of an imaging procedure that uses special x-ray equipment to create detailed pictures, or scans, of areas inside the body called Low Dose Computed tomography (LDCT).
In the USA NLST (National Lung Cancer Screening Trial) LDCT was shown to reduce lung cancer mortality by 20%. The UKLS screening trial also used a ‘state-of-the-art approach’ to identify very early lung cancer nodules.
Improving survival rates
Health economic analysis suggests that the screening intervention would be cost effective; this needs to be confirmed using data on observed lung cancer mortality reduction.
Professor John Field, Clinical Professor of Molecular Oncology and the Chief Investigator of the UKLS trial, said: “The UKLS trial has successfully demonstrated that we have a way to screen for lung cancer in high risk individuals in the UK.
“As UKLS was a pilot trial, however, researchers are currently awaiting the outcome of the Dutch CT screening trial, which will potentially provide mortality data to argue for implementation of a national lung cancer screening programme in the UK.
“If we could detect lung cancer via screening of high risk individuals, it would make a major impact on the diagnosis of lung cancer at an earlier stage of the disease and would greatly improve the survival rates of those affected by this terrible disease.”
Benefitting the area
Dr Edward Gaynor, Clinical lead on cancer for Liverpool Clinical Commissioning Group, said: “The UKLS study is a further piece of evidence that low dose CT in high risk individuals can save lives. This is particularly relevant in Liverpool where we have one of the highest incidences and mortality rates of lung cancer and the Liverpool Clinical Commissioning Group is actively exploring how it can apply the findings in this study to the benefit of Liverpool through the Healthy Lung Project.”
The UKLS trial has received full ethical approval and is published in The Thorax Journal. A copy of the full report can be found here: http://bit.ly/1OPVnRV
