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Pathan RK, Shorna IJ, Hossain MS, Khandaker MU, Almohammed HI, Hamd ZY. The efficacy of machine learning models in lung cancer risk prediction with explainability. PLoS One 2024; 19:e0305035. [PMID: 38870229 PMCID: PMC11175504 DOI: 10.1371/journal.pone.0305035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/22/2024] [Indexed: 06/15/2024] Open
Abstract
Among many types of cancers, to date, lung cancer remains one of the deadliest cancers around the world. Many researchers, scientists, doctors, and people from other fields continuously contribute to this subject regarding early prediction and diagnosis. One of the significant problems in prediction is the black-box nature of machine learning models. Though the detection rate is comparatively satisfactory, people have yet to learn how a model came to that decision, causing trust issues among patients and healthcare workers. This work uses multiple machine learning models on a numerical dataset of lung cancer-relevant parameters and compares performance and accuracy. After comparison, each model has been explained using different methods. The main contribution of this research is to give logical explanations of why the model reached a particular decision to achieve trust. This research has also been compared with a previous study that worked with a similar dataset and took expert opinions regarding their proposed model. We also showed that our research achieved better results than their proposed model and specialist opinion using hyperparameter tuning, having an improved accuracy of almost 100% in all four models.
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Affiliation(s)
- Refat Khan Pathan
- Department of Computing and Information Systems, School of Engineering and Technology, Sunway University, Selangor, Malaysia
| | | | - Md. Sayem Hossain
- School of Computing Science, Faculty of Innovation and Technology, Taylor’s University Lakeside Campus, Selangor, Malaysia
| | - Mayeen Uddin Khandaker
- Applied Physics and Radiation Technologies Group, CCDCU, School of Engineering and Technology, Sunway University, Selangor, Malaysia
- Faculty of Graduate Studies, Daffodil International University, Daffodil Smart City, Savar, Dhaka, Bangladesh
| | - Huda I. Almohammed
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Zuhal Y. Hamd
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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Scobie H, Robb KA, Macdonald S, Harrow S, Sullivan F. Optimising recruitment to a lung cancer screening trial: A comparison of general practitioner and community-based recruitment. J Med Screen 2024; 31:46-52. [PMID: 37525582 PMCID: PMC10878003 DOI: 10.1177/09691413231190785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/07/2023] [Accepted: 07/11/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVES Pre-trial focus groups of the Early detection of Cancer of the Lung Scotland (ECLS) trial indicated that those at high risk of lung cancer are more likely to engage with community-based recruitment methods. The current study aimed to understand if general practitioner (GP) and community-based recruitment might attract different groups of people, and to quantitatively explore the demographic and psychosocial differences between people responding to GP or community-based recruitment. DESIGN Secondary data analysis of ECLS trial baseline data. METHODS Adults (n = 11,164) aged 50 to 75 years completed a baseline questionnaire as part of their participation in the ECLS trial. The questionnaire assessed smoking behaviour, health state, health anxiety and illness perception. Alongside demographic characteristics, how participants were made aware of the study/participant recruitment method (GP recruitment/community recruitment) was also obtained via trial records. RESULTS The likelihood of being recruited via community-based methods increased as deprivation level decreased. Those recruited via the community had higher levels of perceived personal control of developing lung cancer and were more likely to understand their own risk of developing lung cancer, compared to those who were recruited to the trial via their GP. Health state and health anxiety did not predict recruitment methods in multivariable analysis. CONCLUSIONS Community and opportunistic screening invitations were associated with uptake in people from less-deprived backgrounds, and therefore might not be the optimal method to reach those at high risk of lung cancer and living in more deprived areas.
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Affiliation(s)
- Hannah Scobie
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kathryn A Robb
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sara Macdonald
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stephen Harrow
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Frank Sullivan
- School of Medicine, University of St Andrews, St Andrews, Fife, UK
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Alali AA. Level of Education Matters in Regard to Participants' Compliance With Screening in the National Lung Screening Trial. J Thorac Imaging 2024; 39:W1-W4. [PMID: 37732698 DOI: 10.1097/rti.0000000000000741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
PURPOSE The success of cancer screening depends on patient adherence to the screening program. The purpose of this study is to assess how the level of education might affect participants' compliance with screening in the National Lung Screening Trial (NLST). MATERIALS AND METHODS Secondary data analyses of the participants in the NLST were performed. A total of 50,104 participants were included in this study. Participants who enrolled in the trial but refused the initial screening were compared with those who completed the screening. A multivariate logistic regression model was used to assess the association between participant noncompliance and education level. RESULTS A total of 3712 (7.41%) participants refused lung cancer screening in the NLST. Compared with the reference group, participants with an education level of eighth grade or less (odds ratio [OR]: 2.1, CI: 1.68-2.76), ninth-11th grade (OR: 1.9, CI: 1.7-2.34), high school graduates (OR: 1.3, CI: 1.22-1.54), after high school training (OR: 1.1, CI: 1-1.31), or an associate's degree (OR: 1.2, CI: 1.07-1.36) had significantly higher odds of refusing lung cancer screening. Participants with a bachelor's degree showed no significant association with compliance with screening (OR: 0.9, P = 0.86). Multivariate regression analysis also showed that younger, single, male participants with a longer duration of smoking history had significantly higher odds of refusing the screening. CONCLUSION A lower level of education was significantly associated with refusing lung cancer screening. A strategic targeted approach for this group might be necessary to promote their compliance rate.
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Affiliation(s)
- Akeel A Alali
- College of Medicine, Clinical Affairs, King Saud Bin Abdulaziz University for Health Sciences
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Goodley P, Balata H, Alonso A, Brockelsby C, Conroy M, Cooper-Moss N, Craig C, Evison M, Hewitt K, Higgins C, Johnson W, Lyons J, Merchant Z, Rowlands A, Sharman A, Sinnott N, Sperrin M, Booton R, Crosbie PAJ. Invitation strategies and participation in a community-based lung cancer screening programme located in areas of high socioeconomic deprivation. Thorax 2023; 79:58-67. [PMID: 37586744 PMCID: PMC10803959 DOI: 10.1136/thorax-2023-220001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 07/19/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Although lung cancer screening is being implemented in the UK, there is uncertainty about the optimal invitation strategy. Here, we report participation in a community screening programme following a population-based invitation approach, examine factors associated with participation, and compare outcomes with hypothetical targeted invitations. METHODS Letters were sent to all individuals (age 55-80) registered with a general practice (n=35 practices) in North and East Manchester, inviting ever-smokers to attend a Lung Health Check (LHC). Attendees at higher risk (PLCOm2012NoRace score≥1.5%) were offered two rounds of annual low-dose CT screening. Primary care recorded smoking codes (live and historical) were used to model hypothetical targeted invitation approaches for comparison. RESULTS Letters were sent to 35 899 individuals, 71% from the most socioeconomically deprived quintile. Estimated response rate in ever-smokers was 49%; a lower response rate was associated with younger age, male sex, and primary care recorded current smoking status (adjOR 0.55 (95% CI 0.52 to 0.58), p<0.001). 83% of eligible respondents attended an LHC (n=8887/10 708). 51% were eligible for screening (n=4540/8887) of whom 98% had a baseline scan (n=4468/4540). Screening adherence was 83% (n=3488/4199) and lung cancer detection 3.2% (n=144) over 2 rounds. Modelled targeted approaches required 32%-48% fewer invitations, identified 94.6%-99.3% individuals eligible for screening, and included 97.1%-98.6% of screen-detected lung cancers. DISCUSSION Using a population-based invitation strategy, in an area of high socioeconomic deprivation, is effective and may increase screening accessibility. Due to limitations in primary care records, targeted approaches should incorporate historical smoking codes and individuals with absent smoking records.
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Affiliation(s)
- Patrick Goodley
- Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester, Manchester, UK
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Haval Balata
- Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester, Manchester, UK
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Alberto Alonso
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Christopher Brockelsby
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Matthew Conroy
- Manchester Integrated Care Partnership (NHS Greater Manchester), Manchester, UK
| | | | - Christopher Craig
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Matthew Evison
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Kath Hewitt
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Coral Higgins
- Manchester Integrated Care Partnership (NHS Greater Manchester), Manchester, UK
| | - William Johnson
- Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Judith Lyons
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Zoe Merchant
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Ailsa Rowlands
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Anna Sharman
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Nicola Sinnott
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Matthew Sperrin
- Division of Informatics Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Richard Booton
- Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester, Manchester, UK
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Philip A J Crosbie
- Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester, Manchester, UK
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
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Darnaud N, Mory JE, Romy P, Berger J, Eve K, Lantheaume S. Perceptions and feelings of a French sample regarding lung cancer screening. BMC Public Health 2023; 23:2333. [PMID: 38001431 PMCID: PMC10675874 DOI: 10.1186/s12889-023-17110-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION This study investigated the perceptions and feelings of a French sample about the possible introduction of lung cancer screening. METHODS A total of 146 individuals, aged between 19- and 64-years, participated in this study conducted between November 2020 and January 2021. Participants were divided into three groups according to their smoking status: (i) active smokers (G1); former smokers (G2); and non-smokers (G3). Each individual completed an online questionnaire evaluating their perceptions and feelings about lung cancer, screening and scans. RESULTS Overall, a higher percentage of former smokers (47%) indicated a greater willingness to participate in lung cancer screening compared to active smokers (19%) and non-smokers (32%). Active smokers and former smokers reported anxiety about the development of lung cancer. Active smokers who wished to participate in screening reported a greater motivation to reduce their tobacco consumption. The perception of lung cancer risk had less influence than age and socio-economic category on the participation in screening. Finally, stigma did not appear to be a barrier to undergoing screening. CONCLUSION Active and former smokers were generally optimistic about screening; however, active smokers showed less inclination to participate in screening compared to former smokers and non-smokers. Three main factors appeared to influence this participation: the perception of the risk of developing cancer, age and socio-economic category.
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Affiliation(s)
- Nicolas Darnaud
- Institut Supérieur Technologique Montplaisir, Valence, France
| | - Jean-Eudes Mory
- Ramsay Santé Hôpital Privé Drôme Ardèche, Guilherand-Granges, France
| | - Pascal Romy
- Ramsay Santé Hôpital Privé Drôme Ardèche, Guilherand-Granges, France
| | - Jacques Berger
- Ramsay Santé Hôpital Privé Drôme Ardèche, Guilherand-Granges, France
| | - Karine Eve
- Institut Supérieur Technologique Montplaisir, Valence, France
| | - Sophie Lantheaume
- Institut Supérieur Technologique Montplaisir, Valence, France.
- Ramsay Santé Hôpital Privé Drôme Ardèche, Guilherand-Granges, France.
- Laboratoire Inter-Universitaire de Psychologie, Personnalité, Cognition, Changement Social (LIP/PC2S), Université Grenoble Alpes, Grenoble, France.
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Reilly M, Ali A, Doyle PF, Cotter S, Heavey L, Brain PK, Rankin PN, Mccutchan G, Redmond PP. Co-designing a recruitment strategy for lung cancer screening in high-risk individuals: protocol for a mixed-methods study. HRB Open Res 2023; 6:64. [PMID: 38911612 PMCID: PMC11190654 DOI: 10.12688/hrbopenres.13793.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 06/25/2024] Open
Abstract
Background Lung cancer is a significant cause of cancer-related mortality globally, with early detection through screening critical to improving patient outcomes. However, recruiting high-risk individuals, particularly in deprived populations, for screening remains a considerable challenge. This study aims to co-design a targeted recruitment strategy for lung cancer screening, tailored to the specific needs and experiences of high-risk individuals, in collaboration with a Patient and Public Involvement (PPI) panel and expert stakeholders in Ireland. Methods We will employ a mixed-methods design guided by the Medical Research Council (MRC) framework for developing complex interventions. Our approach will integrate systematic review findings on screening participation interventions, evaluation of the recruitment strategy's feasibility in an Irish context, and the application of behavioural science frameworks. The target population includes individuals over 55 years, either current smokers or those who quit within the last year, who reside in highly deprived areas. Conclusion This co-designed recruitment strategy will combine evidence-based research, local context understanding, and stakeholder input to develop a solution that is both scientifically robust and tailored to the target population's needs. This patient-centred approach aims to increase the potential for successful implementation of lung cancer screening programs, thereby improving early detection and patient outcomes.
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Affiliation(s)
- Maeve Reilly
- Department of General Practice, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Ahmeda Ali
- Department of General Practice, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Prof Frank Doyle
- Department of Health Psychology, School of Population Health, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Seamus Cotter
- Patient and Public Involvement (PPI), Irish Lung Cancer Community, Dublin, Ireland
| | - Laura Heavey
- National Screening Service, Health Service Executive (HSE), Dublin, Ireland
| | - Prof Kate Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Prof Nicole Rankin
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Grace Mccutchan
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Prof Patrick Redmond
- Department of General Practice, Royal College of Surgeons Ireland, Dublin, Ireland
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Cellina M, Cacioppa LM, Cè M, Chiarpenello V, Costa M, Vincenzo Z, Pais D, Bausano MV, Rossini N, Bruno A, Floridi C. Artificial Intelligence in Lung Cancer Screening: The Future Is Now. Cancers (Basel) 2023; 15:4344. [PMID: 37686619 PMCID: PMC10486721 DOI: 10.3390/cancers15174344] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/27/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Lung cancer has one of the worst morbidity and fatality rates of any malignant tumour. Most lung cancers are discovered in the middle and late stages of the disease, when treatment choices are limited, and patients' survival rate is low. The aim of lung cancer screening is the identification of lung malignancies in the early stage of the disease, when more options for effective treatments are available, to improve the patients' outcomes. The desire to improve the efficacy and efficiency of clinical care continues to drive multiple innovations into practice for better patient management, and in this context, artificial intelligence (AI) plays a key role. AI may have a role in each process of the lung cancer screening workflow. First, in the acquisition of low-dose computed tomography for screening programs, AI-based reconstruction allows a further dose reduction, while still maintaining an optimal image quality. AI can help the personalization of screening programs through risk stratification based on the collection and analysis of a huge amount of imaging and clinical data. A computer-aided detection (CAD) system provides automatic detection of potential lung nodules with high sensitivity, working as a concurrent or second reader and reducing the time needed for image interpretation. Once a nodule has been detected, it should be characterized as benign or malignant. Two AI-based approaches are available to perform this task: the first one is represented by automatic segmentation with a consequent assessment of the lesion size, volume, and densitometric features; the second consists of segmentation first, followed by radiomic features extraction to characterize the whole abnormalities providing the so-called "virtual biopsy". This narrative review aims to provide an overview of all possible AI applications in lung cancer screening.
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Affiliation(s)
- Michaela Cellina
- Radiology Department, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, 20121 Milano, Italy;
| | - Laura Maria Cacioppa
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (L.M.C.); (N.R.); (A.B.)
- Division of Interventional Radiology, Department of Radiological Sciences, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
| | - Maurizio Cè
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (M.C.); (V.C.); (M.C.); (Z.V.); (D.P.); (M.V.B.)
| | - Vittoria Chiarpenello
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (M.C.); (V.C.); (M.C.); (Z.V.); (D.P.); (M.V.B.)
| | - Marco Costa
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (M.C.); (V.C.); (M.C.); (Z.V.); (D.P.); (M.V.B.)
| | - Zakaria Vincenzo
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (M.C.); (V.C.); (M.C.); (Z.V.); (D.P.); (M.V.B.)
| | - Daniele Pais
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (M.C.); (V.C.); (M.C.); (Z.V.); (D.P.); (M.V.B.)
| | - Maria Vittoria Bausano
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (M.C.); (V.C.); (M.C.); (Z.V.); (D.P.); (M.V.B.)
| | - Nicolò Rossini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (L.M.C.); (N.R.); (A.B.)
| | - Alessandra Bruno
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (L.M.C.); (N.R.); (A.B.)
| | - Chiara Floridi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (L.M.C.); (N.R.); (A.B.)
- Division of Interventional Radiology, Department of Radiological Sciences, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
- Division of Radiology, Department of Radiological Sciences, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
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O'Dowd EL, Lee RW, Akram AR, Bartlett EC, Bradley SH, Brain K, Callister MEJ, Chen Y, Devaraj A, Eccles SR, Field JK, Fox J, Grundy S, Janes SM, Ledson M, MacKean M, Mackie A, McManus KG, Murray RL, Nair A, Quaife SL, Rintoul R, Stevenson A, Summers Y, Wilkinson LS, Booton R, Baldwin DR, Crosbie P. Defining the road map to a UK national lung cancer screening programme. Lancet Oncol 2023; 24:e207-e218. [PMID: 37142382 DOI: 10.1016/s1470-2045(23)00104-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 05/06/2023]
Abstract
Lung cancer screening with low-dose CT was recommended by the UK National Screening Committee (UKNSC) in September, 2022, on the basis of data from trials showing a reduction in lung cancer mortality. These trials provide sufficient evidence to show clinical efficacy, but further work is needed to prove deliverability in preparation for a national roll-out of the first major targeted screening programme. The UK has been world leading in addressing logistical issues with lung cancer screening through clinical trials, implementation pilots, and the National Health Service (NHS) England Targeted Lung Health Check Programme. In this Policy Review, we describe the consensus reached by a multiprofessional group of experts in lung cancer screening on the key requirements and priorities for effective implementation of a programme. We summarise the output from a round-table meeting of clinicians, behavioural scientists, stakeholder organisations, and representatives from NHS England, the UKNSC, and the four UK nations. This Policy Review will be an important tool in the ongoing expansion and evolution of an already successful programme, and provides a summary of UK expert opinion for consideration by those organising and delivering lung cancer screenings in other countries.
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Affiliation(s)
- Emma L O'Dowd
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Richard W Lee
- Early Diagnosis and Detection Centre, National Institute for Health and Care Research Biomedical Research Centre at the Royal Marsden and Institute of Cancer Research, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
| | - Ahsan R Akram
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK; Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Emily C Bartlett
- Royal Brompton and Harefield Hospitals London and National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Kate Brain
- Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | | | - Yan Chen
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Anand Devaraj
- Royal Brompton and Harefield Hospitals London and National Heart and Lung Institute, Imperial College London, London, UK
| | - Sinan R Eccles
- Royal Glamorgan Hospital, Cwm Taf Morgannwg University Health Board, Llantrisant, UK
| | - John K Field
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Jesme Fox
- Roy Castle Lung Cancer Foundation, Liverpool, UK
| | - Seamus Grundy
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Sam M Janes
- Lungs for Living Research Centre, Department of Respiratory Medicine, University College London, London, UK
| | - Martin Ledson
- Department of Respiratory Medicine, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | | | - Kieran G McManus
- Department of Thoracic Surgery, Royal Victoria Hospital, Belfast, UK
| | - Rachael L Murray
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Arjun Nair
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Samantha L Quaife
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Robert Rintoul
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Anne Stevenson
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Yvonne Summers
- The Christie Hospital NHS Trust, Manchester University NHS Foundation Trust, Manchester, UK
| | - Louise S Wilkinson
- Oxford Breast Imaging Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Booton
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Philip Crosbie
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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9
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Bonfield S, Ruparel M, Waller J, Dickson JL, Janes SM, Quaife SL. Preferences for Decision Control among a High-Risk Cohort Offered Lung Cancer Screening: A Brief Report of Secondary Analyses from the Lung Screen Uptake Trial (LSUT). MDM Policy Pract 2023; 8:23814683231163190. [PMID: 37009636 PMCID: PMC10064161 DOI: 10.1177/23814683231163190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/16/2023] [Indexed: 03/30/2023] Open
Abstract
Background. Personal autonomy in lung cancer screening is advocated internationally, but health systems diverge in their approach, mandating either shared decision making (with a health care professional) or individual decision making. Studies of other cancer screening programs have found that individual preferences for the level of involvement in screening decisions vary across different sociodemographic groups and that aligning approaches with individual preferences has the potential to improve uptake. Method. For the first time, we examined preferences for decision control among a cohort of UK-based high-risk lung cancer screening candidates ( N = 727). We used descriptive statistics to report the distribution of preferences and chi-square tests to examine associations between decision preferences and sociodemographic variables. Results. Most (69.7%) preferred to be involved in the decision with varying degrees of input from a health care professional. Few (10.2%) wanted to make the decision alone. Preferences were also associated with educational attainment. Conclusion. These findings suggest one-size-fits-all approaches may be inadequate in meeting diverse preferences, particularly those placing sole onus on the individual. Highlights Preferences for involvement in decision making about lung cancer screening are heterogeneous among high-risk individuals in the United Kingdom and vary by educational attainment. Further work is needed to understand how policy makers might implement hybrid approaches to accommodate individual preferences and optimize lung cancer screening program outcomes.
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Affiliation(s)
- Stefanie Bonfield
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Jo Waller
- School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Jennifer L. Dickson
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Samuel M. Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Samantha L. Quaife
- Samantha L. Quaife, Centre for Cancer Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK; ()
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10
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Cavers D, Nelson M, Rostron J, Robb KA, Brown LR, Campbell C, Akram AR, Dickie G, Mackean M, van Beek EJR, Sullivan F, Steele RJ, Neilson AR, Weller D. Understanding patient barriers and facilitators to uptake of lung screening using low dose computed tomography: a mixed methods scoping review of the current literature. Respir Res 2022; 23:374. [PMID: 36564817 PMCID: PMC9789658 DOI: 10.1186/s12931-022-02255-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Targeted lung cancer screening is effective in reducing mortality by upwards of twenty percent. However, screening is not universally available and uptake is variable and socially patterned. Understanding screening behaviour is integral to designing a service that serves its population and promotes equitable uptake. We sought to review the literature to identify barriers and facilitators to screening to inform the development of a pilot lung screening study in Scotland. METHODS We used Arksey and O'Malley's scoping review methodology and PRISMA-ScR framework to identify relevant literature to meet the study aims. Qualitative, quantitative and mixed methods primary studies published between January 2000 and May 2021 were identified and reviewed by two reviewers for inclusion, using a list of search terms developed by the study team and adapted for chosen databases. RESULTS Twenty-one articles met the final inclusion criteria. Articles were published between 2003 and 2021 and came from high income countries. Following data extraction and synthesis, findings were organised into four categories: Awareness of lung screening, Enthusiasm for lung screening, Barriers to lung screening, and Facilitators or ways of promoting uptake of lung screening. Awareness of lung screening was low while enthusiasm was high. Barriers to screening included fear of a cancer diagnosis, low perceived risk of lung cancer as well as practical barriers of cost, travel and time off work. Being health conscious, provider endorsement and seeking reassurance were all identified as facilitators of screening participation. CONCLUSIONS Understanding patient reported barriers and facilitators to lung screening can help inform the implementation of future lung screening pilots and national lung screening programmes.
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Affiliation(s)
- Debbie Cavers
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Mia Nelson
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Jasmin Rostron
- The National Institute of Economic and Social Research, 2 Dean Trench Street, London, NW1P 3HE UK
| | - Kathryn A. Robb
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ UK
| | - Lynsey R. Brown
- School of Medicine, University of St. Andrews, North Haugh, St. Andrews, KY16 9TF UK
| | - Christine Campbell
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Ahsan R. Akram
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Graeme Dickie
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Melanie Mackean
- Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU UK
| | - Edwin J. R. van Beek
- Edinburgh Imaging, Queen’s Medical Research Institute, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4TJ UK
| | - Frank Sullivan
- School of Medicine, University of St. Andrews, North Haugh, St. Andrews, KY16 9TF UK
| | - Robert J. Steele
- School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY UK
| | - Aileen R. Neilson
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - David Weller
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
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11
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Crosbie PAJ, Gabe R, Simmonds I, Hancock N, Alexandris P, Kennedy M, Rogerson S, Baldwin D, Booton R, Bradley C, Darby M, Eckert C, Franks KN, Lindop J, Janes SM, Møller H, Murray RL, Neal RD, Quaife SL, Upperton S, Shinkins B, Tharmanathan P, Callister MEJ. Participation in community-based lung cancer screening: the Yorkshire Lung Screening Trial. Eur Respir J 2022; 60:2200483. [PMID: 35777775 PMCID: PMC9684623 DOI: 10.1183/13993003.00483-2022] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/17/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Screening with low-dose computed tomography (LDCT) reduces lung cancer mortality; however, the most effective strategy for optimising participation is unknown. Here we present data from the Yorkshire Lung Screening Trial, including response to invitation, screening eligibility and uptake of community-based LDCT screening. METHODS Individuals aged 55-80 years, identified from primary care records as having ever smoked, were randomised prior to consent to invitation to telephone lung cancer risk assessment or usual care. The invitation strategy included general practitioner endorsement, pre-invitation and two reminder invitations. After telephone triage, those at higher risk were invited to a Lung Health Check (LHC) with immediate access to a mobile CT scanner. RESULTS Of 44 943 individuals invited, 50.8% (n=22 815) responded and underwent telephone-based risk assessment (16.7% and 7.3% following first and second reminders, respectively). A lower response rate was associated with current smoking status (adjusted OR 0.44, 95% CI 0.42-0.46) and socioeconomic deprivation (adjusted OR 0.58, 95% CI 0.54-0.62 for the most versus the least deprived quintile). Of those responding, 34.4% (n=7853) were potentially eligible for screening and offered a LHC, of whom 86.8% (n=6819) attended. Lower uptake was associated with current smoking status (adjusted OR 0.73, 95% CI 0.62-0.87) and socioeconomic deprivation (adjusted OR 0.78, 95% CI 0.62-0.98). In total, 6650 individuals had a baseline LDCT scan, representing 99.7% of eligible LHC attendees. CONCLUSIONS Telephone risk assessment followed by a community-based LHC is an effective strategy for lung cancer screening implementation. However, lower participation associated with current smoking status and socioeconomic deprivation underlines the importance of research to ensure equitable access to screening.
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Affiliation(s)
- Philip A J Crosbie
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
- These two authors contributed equally
| | - Rhian Gabe
- Centre for Cancer Prevention, Queen Mary University of London, London, UK
- These two authors contributed equally
| | - Irene Simmonds
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Neil Hancock
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Panos Alexandris
- Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | | | | | - David Baldwin
- Dept of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - Richard Booton
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Claire Bradley
- Craigavon Area Hospital, Southern Health and Social Care Trust, Portadown, UK
| | - Mike Darby
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Claire Eckert
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kevin N Franks
- Institute of Health Sciences, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Henrik Møller
- The Danish Clinical Quality Program and Clinical Registries (RKKP), Aarhus, Denmark
| | - Rachael L Murray
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Richard D Neal
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Samantha L Quaife
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | | | | | - Matthew E J Callister
- Institute of Health Sciences, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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12
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Balata H, Quaife SL, Craig C, Ryan DJ, Bradley P, Crosbie PAJ, Murray RL, Evison M. Early Diagnosis and Lung Cancer Screening. Clin Oncol (R Coll Radiol) 2022; 34:708-715. [PMID: 36175244 DOI: 10.1016/j.clon.2022.08.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/19/2022] [Accepted: 08/31/2022] [Indexed: 01/31/2023]
Abstract
Lung cancer remains the most significant cause of cancer death, accounting for about 20% of all cancer-related mortality. A significant reason for this is delayed diagnosis, either due to lack of symptoms in early-stage disease or presentation with non-specific symptoms common with a broad range of alternative diagnoses. More is needed in terms of increasing public awareness, providing adequate healthcare professional education and implementing clinical pathways that improve the earlier diagnosis of symptomatic lung cancer. Low-dose computed tomography screening of high-risk, asymptomatic populations has been shown to reduce lung cancer mortality, with focus now shifting towards how best to implement lung cancer screening on a wider scale in a safe, efficient and cost-effective manner. For maximum benefit, efforts must be made to optimise uptake, especially among high-risk populations with significant socioeconomic deprivation, as well as successfully incorporate tobacco-dependency treatment. Quality assured programme management will be critical to minimising screening-related harms and adequately managing incidental findings. By undertaking the above, there can be optimism that lung cancer outcomes can be improved significantly in the near future.
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Affiliation(s)
- H Balata
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - S L Quaife
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - C Craig
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - D J Ryan
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - P Bradley
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - P A J Crosbie
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - R L Murray
- Academic Unit of Lifespan and Population Health, Faculty of Medicine & Health Sciences, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, UK
| | - M Evison
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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13
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Wood DE, Kazerooni EA, Aberle D, Berman A, Brown LM, Eapen GA, Ettinger DS, Ferguson JS, Hou L, Kadaria D, Klippenstein D, Kumar R, Lackner RP, Leard LE, Lennes IT, Leung ANC, Mazzone P, Merritt RE, Midthun DE, Onaitis M, Pipavath S, Pratt C, Puri V, Raz D, Reddy C, Reid ME, Sandler KL, Sands J, Schabath MB, Studts JL, Tanoue L, Tong BC, Travis WD, Wei B, Westover K, Yang SC, McCullough B, Hughes M. NCCN Guidelines® Insights: Lung Cancer Screening, Version 1.2022. J Natl Compr Canc Netw 2022; 20:754-764. [PMID: 35830884 DOI: 10.6004/jnccn.2022.0036] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The NCCN Guidelines for Lung Cancer Screening recommend criteria for selecting individuals for screening and provide recommendations for evaluation and follow-up of lung nodules found during initial and subsequent screening. These NCCN Guidelines Insights focus on recent updates to the NCCN Guidelines for Lung Cancer Screening.
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Affiliation(s)
- Douglas E Wood
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Abigail Berman
- Abramson Cancer Center at the University of Pennsylvania
| | | | | | | | | | - Lifang Hou
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Dipen Kadaria
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | | | | | | | - Peter Mazzone
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Robert E Merritt
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | - Mark Onaitis
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Varun Puri
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Dan Raz
- City of Hope National Medical Center
| | | | | | | | - Jacob Sands
- Dana-Farber/Brigham and Women's Cancer Center
| | | | | | | | | | | | | | | | - Stephen C Yang
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
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14
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Goo JM, Jung KW, Kim HY, Kim Y. Potential Overdiagnosis with CT Lung Cancer Screening in Taiwanese Female: Status in South Korea. Korean J Radiol 2022; 23:571-573. [PMID: 35617992 PMCID: PMC9174499 DOI: 10.3348/kjr.2022.0190] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/27/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jin Mo Goo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology and Institution of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea.
| | - Kyu-Won Jung
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Hyae Young Kim
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
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15
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Quaife SL, Brain KE, Stevens C, Kurtidu C, Janes SM, Waller J. Development and psychometric testing of the self-regulatory questionnaire for lung cancer screening (SRQ-LCS). Psychol Health 2022; 37:194-210. [PMID: 33593154 DOI: 10.1080/08870446.2021.1879806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 01/06/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Research implicates psychological factors in low uptake of lung cancer screening. We developed and psychometrically tested a standardised measure of these psychological determinants in preparation for a prospective, longitudinal cohort study of screening uptake. METHODS Leventhal's Common-Sense Model of Self-Regulation of Health and Illness provided the theoretical framework to generate the initial item pool. Items were refined during expert review and cognitive interviews which tested for face validity, redundancy, acceptability and comprehensibility. An online survey piloted the refined pool with 1500 current and former (quit ≤ 15 years) smokers aged 55-80. The response distributions, internal reliability and factor structure determined the final retained constructs. Regression analyses examined these constructs' associations with screening intention, smoking status and demographics. RESULTS The final measure included seven factor-derived subscales (consequences, personal control, treatment control, illness coherence, emotional representation, behavioural response and appraisal, risk perception) with Cronbach's alphas ranging from 0.59 to 0.91 and four single-item questions (response efficacy for smoking cessation, treatment intention, perceived stigma and lung cancer survival). Most constructs were associated with smoking status and screening intention (p's < .05). CONCLUSIONS The Self-Regulatory Questionnaire for Lung Cancer Screening (SRQ-LCS) is an acceptable, reliable and valid measure for investigating the psychological determinants of screening uptake.
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Affiliation(s)
- Samantha L Quaife
- Research Department of Behavioural Science and Health, University College London, London, UK
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Kate E Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Claire Stevens
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Clara Kurtidu
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Samuel M Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, UK
| | - Jo Waller
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
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16
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Ten Haaf K. Risk-based lung cancer screening eligibility criteria: towards implementation. Lancet Oncol 2021; 23:13-14. [PMID: 34902333 DOI: 10.1016/s1470-2045(21)00636-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 12/23/2022]
Affiliation(s)
- Kevin Ten Haaf
- Erasmus MC, University Medical Centre Rotterdam, Department of Public Health, 3000 CA Rotterdam, Netherlands.
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17
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Quaife SL, Waller J, Dickson JL, Brain KE, Kurtidu C, McCabe J, Hackshaw A, Duffy SW, Janes SM. Psychological Targets for Lung Cancer Screening Uptake: A Prospective Longitudinal Cohort Study. J Thorac Oncol 2021; 16:2016-2028. [PMID: 34403828 DOI: 10.1016/j.jtho.2021.07.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Low uptake of low-dose computed tomography lung cancer screening by high-risk groups compromises its effectiveness and equity as a population-level early detection strategy. Numerous psychological factors are implicated qualitatively or retrospectively, but prospective data are needed to validate their associations with uptake behavior and specify psychological targets for intervention. METHODS This is a prospective, longitudinal cohort study evaluating psychological correlates of lung cancer screening uptake. Ever-smokers (aged 55-77 y) were invited to a lung health check, at which low-dose computed tomography screening was offered through the SUMMIT Study-a multicenter screening implementation trial. One week after their screening invitation, 44,000 invitees were mailed the self-regulatory questionnaire for lung cancer screening. Regression analyses evaluated the constructs' associations with uptake (telephoning for an appointment) and sociodemographic characteristics. RESULTS Higher odds of uptake were associated with both positive and negative perceptions. Positive perceptions included lung cancer controllability, benefits of early diagnosis, improved survival when lung cancer is detected early, willingness to be treated, and believing smoking cessation is effective in reducing risk. Negative perceptions included a higher lung cancer risk perception, negative beliefs about the consequences of lung cancer, perceiving lung cancer as stigmatized, and a negative emotional response. Although current smokers held the highest risk perceptions, they also reported negative perceptions that could undermine how they behave in response to their risk. CONCLUSIONS Interventions to improve uptake should focus on changing perceptions that affect how an individual reacts when they believe their risk of lung cancer is high.
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Affiliation(s)
- Samantha L Quaife
- Wolfson Institute of Population Health, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
| | - Jo Waller
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Jennifer L Dickson
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, United Kingdom
| | - Kate E Brain
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Clara Kurtidu
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - John McCabe
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, United Kingdom
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, Cancer Institute, University College London, London, United Kingdom
| | - Stephen W Duffy
- Wolfson Institute of Population Health, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Samuel M Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, United Kingdom
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18
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Broadbent R, Gorman L, Armitage CJ, Radford J, Linton K. The perspectives of survivors of Hodgkin lymphoma on lung cancer screening: A qualitative study. Health Expect 2021; 25:116-124. [PMID: 34755419 DOI: 10.1111/hex.13353] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/21/2021] [Accepted: 08/12/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Hodgkin lymphoma survivors (HLS) are at excess risk of lung cancer as a consequence of HL treatment. HLS without a heavy smoking history are currently unable to access lung cancer screening (LCS) programmes aimed at ever smokers, and there is an unmet need to develop a targeted LCS programme. In this study we prospectively explored HLS perspectives on a future LCS programme, including motivating factors and potential barriers to participation, with the aim of identifying ways to optimise uptake in a future programme. METHODS Semistructured telephone interviews were conducted with HLS, aged 18-80 and lymphoma-free for ≥5 years, selected from a clinical database (ADAPT). Participants provided informed consent. Data were analysed using inductive thematic analysis. RESULTS Despite awareness of other late effects, most participants were unaware of their excess risk of lung cancer. Most were willing to participate in a future LCS programme, citing the potential curability of early-stage lung cancer and reassurance as motivating factors, whilst prior experience of healthcare was a facilitator. Whilst the screening test (a low dose CT scan) was considered acceptable, radiation risk was a concern for some and travel and time off work were potential barriers to participation. CONCLUSIONS Our results suggest that most HLS would participate in a future LCS programme, motivated by perceived benefits. Their feedback identified a need to develop educational materials addressing lung cancer risk and concerns about screening, including radiation risk. Such materials could be provided upon an invitation to LCS. Uptake in a future programme may be further optimized by offering flexible screening appointments close to home.
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Affiliation(s)
- Rachel Broadbent
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK.,The Christie NHS Foundation Trust, Manchester, UK
| | - Louise Gorman
- NIHR Greater Manchester Patient Safety Translational Research Centre, Centre for Mental Health and Safety, Division of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Christopher J Armitage
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK.,Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - John Radford
- Manchester Cancer Research Centre, Manchester, UK
| | - Kim Linton
- Manchester Cancer Research Centre, Manchester, UK
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19
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O'Dowd EL, Ten Haaf K, Kaur J, Duffy SW, Hamilton W, Hubbard RB, Field JK, Callister ME, Janes SM, de Koning HJ, Rawlinson J, Baldwin DR. Selection of eligible participants for screening for lung cancer using primary care data. Thorax 2021; 77:882-890. [PMID: 34716280 DOI: 10.1136/thoraxjnl-2021-217142] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 09/21/2021] [Indexed: 12/23/2022]
Abstract
Lung cancer screening is effective if offered to people at increased risk of the disease. Currently, direct contact with potential participants is required for evaluating risk. A way to reduce the number of ineligible people contacted might be to apply risk-prediction models directly to digital primary care data, but model performance in this setting is unknown. METHOD The Clinical Practice Research Datalink, a computerised, longitudinal primary care database, was used to evaluate the Liverpool Lung Project V.2 (LLPv2) and Prostate Lung Colorectal and Ovarian (modified 2012) (PLCOm2012) models. Lung cancer occurrence over 5-6 years was measured in ever-smokers aged 50-80 years and compared with 5-year (LLPv2) and 6-year (PLCOm2012) predicted risk. RESULTS Over 5 and 6 years, 7123 and 7876 lung cancers occurred, respectively, from a cohort of 842 109 ever-smokers. After recalibration, LLPV2 produced a c-statistic of 0.700 (0.694-0.710), but mean predicted risk was over-estimated (predicted: 4.61%, actual: 0.9%). PLCOm2012 showed similar performance (c-statistic: 0.679 (0.673-0.685), predicted risk: 3.76%. Applying risk-thresholds of 1% (LLPv2) and 0.15% (PLCOm2012), would avoid contacting 42.7% and 27.4% of ever-smokers who did not develop lung cancer for screening eligibility assessment, at the cost of missing 15.6% and 11.4% of lung cancers. CONCLUSION Risk-prediction models showed only moderate discrimination when applied to routinely collected primary care data, which may be explained by quality and completeness of data. However, they may substantially reduce the number of people for initial evaluation of screening eligibility, at the cost of missing some lung cancers. Further work is needed to establish whether newer models have improved performance in primary care data.
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Affiliation(s)
- Emma L O'Dowd
- Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kevin Ten Haaf
- Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jaspreet Kaur
- Department of Epidemiology, University of Nottingham School of Medicine, Nottingham, UK
| | - Stephen W Duffy
- Wolfson Institute of Preventive Medicine, Barts and London, London, UK
| | | | - Richard B Hubbard
- Department of Epidemiology, University of Nottingham School of Medicine, Nottingham, UK
| | - John K Field
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, University of Liverpool, Liverpool, UK
| | | | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | | | | | - David R Baldwin
- City Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
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20
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Rankin NM, McWilliams A, Marshall HM. Lung cancer screening implementation: Complexities and priorities. Respirology 2021; 25 Suppl 2:5-23. [PMID: 33200529 DOI: 10.1111/resp.13963] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/17/2022]
Abstract
Lung cancer is the number one cause of cancer death worldwide. The benefits of lung cancer screening to reduce mortality and detect early-stage disease are no longer in any doubt based on the results of two landmark trials using LDCT. Lung cancer screening has been implemented in the US and South Korea and is under consideration by other communities. Successful translation of demonstrated research outcomes into the routine clinical setting requires careful implementation and co-ordinated input from multiple stakeholders. Implementation aspects may be specific to different healthcare settings. Important knowledge gaps remain, which must be addressed in order to optimize screening benefits and minimize screening harms. Lung cancer screening differs from all other cancer screening programmes as lung cancer risk is driven by smoking, a highly stigmatized behaviour. Stigma, along with other factors, can impact smokers' engagement with screening, meaning that smokers are generally 'hard to reach'. This review considers critical points along the patient journey. The first steps include selecting a risk threshold at which to screen, successfully engaging the target population and maximizing screening uptake. We review barriers to smoker engagement in lung and other cancer screening programmes. Recruitment strategies used in trials and real-world (clinical) programmes and associated screening uptake are reviewed. To aid cross-study comparisons, we propose a standardized nomenclature for recording and calculating recruitment outcomes. Once participants have engaged with the screening programme, we discuss programme components that are critical to maximize net benefit. A whole-of-programme approach is required including a standardized and multidisciplinary approach to pulmonary nodule management, incorporating probabilistic nodule risk assessment and longitudinal volumetric analysis, to reduce unnecessary downstream investigations and surgery; the integration of smoking cessation; and identification and intervention for other tobacco related diseases, such as coronary artery calcification and chronic obstructive pulmonary disease. National support, integrated with tobacco control programmes, and with appropriate funding, accreditation, data collection, quality assurance and reporting mechanisms will enhance lung cancer screening programme success and reduce the risks associated with opportunistic, ad hoc screening. Finally, implementation research must play a greater role in informing policy change about targeted LDCT screening programmes.
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Affiliation(s)
- Nicole M Rankin
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Annette McWilliams
- Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, WA, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.,Thoracic Tumour Collaborative of Western Australia, Western Australia Cancer and Palliative Care Network, Perth, WA, Australia
| | - Henry M Marshall
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia.,The University of Queensland Thoracic Research Centre, Brisbane, QLD, Australia
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21
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Ten Haaf K, van der Aalst CM, de Koning HJ, Kaaks R, Tammemägi MC. Personalising lung cancer screening: An overview of risk-stratification opportunities and challenges. Int J Cancer 2021; 149:250-263. [PMID: 33783822 PMCID: PMC8251929 DOI: 10.1002/ijc.33578] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/04/2021] [Accepted: 03/12/2021] [Indexed: 12/17/2022]
Abstract
Randomised clinical trials have shown the efficacy of computed tomography lung cancer screening, initiating discussions on whether and how to implement population‐based screening programs. Due to smoking behaviour being the primary risk‐factor for lung cancer and part of the criteria for determining screening eligibility, lung cancer screening is inherently risk‐based. In fact, the selection of high‐risk individuals has been shown to be essential in implementing lung cancer screening in a cost‐effective manner. Furthermore, studies have shown that further risk‐stratification may improve screening efficiency, allow personalisation of the screening interval and reduce health disparities. However, implementing risk‐based lung cancer screening programs also requires overcoming a number of challenges. There are indications that risk‐based approaches can negatively influence the trade‐off between individual benefits and harms if not applied thoughtfully. Large‐scale implementation of targeted, risk‐based screening programs has been limited thus far. Consequently, questions remain on how to efficiently identify and invite high‐risk individuals from the general population. Finally, while risk‐based approaches may increase screening program efficiency, efficiency should be balanced with the overall impact of the screening program. In this review, we will address the opportunities and challenges in applying risk‐stratification in different aspects of lung cancer screening programs, as well as the balance between screening program efficiency and impact.
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Affiliation(s)
- Kevin Ten Haaf
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Carlijn M van der Aalst
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Martin C Tammemägi
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
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22
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Quaife SL, Janes SM, Brain KE. The person behind the nodule: a narrative review of the psychological impact of lung cancer screening. Transl Lung Cancer Res 2021; 10:2427-2440. [PMID: 34164290 PMCID: PMC8182717 DOI: 10.21037/tlcr-20-1179] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/12/2021] [Indexed: 12/28/2022]
Abstract
Lung cancer is the leading cause of cancer mortality globally, responsible for an estimated 1.76 million deaths worldwide in 2018 alone. Screening adults at high risk of lung cancer using low-dose computed tomography (LDCT) significantly reduces lung cancer mortality by finding the disease at an early, treatable stage. Many countries are actively considering whether to implement screening for their high-risk populations in light of the recently published Dutch-Belgian trial 'NELSON'. In deciding whether to implement a national screening programme, policymakers must weigh up the evidence for the relative risks posed to the entire screened population, including the potential psychological burden. This narrative review aimed to critically summarise the evidence for both negative and positive psychological responses experienced throughout the LDCT screening pathway, to describe their magnitude, duration and clinical relevance, and to draw out different aspects of measurement design crucial to their interpretation. A further aim was to discuss the available evidence for individual differences in psychological response, as well as interventions designed to promote psychological well-being. In summary, there was no evidence that the LDCT screening process caused adverse psychological outcomes overall, although those receiving indeterminate and suspicious LDCT results did report clinically raised anxiety and lung cancer-specific distress in the short-term. There was early evidence that demographic factors, smoking status and screening-ineligibility could be associated with individual differences in propensity to experience distress. Qualitative data suggested health beliefs could be modifiable mediators of these individual differences, but their aetiology requires quantitative and prospective research. There was also some evidence of positive psychological responses that could be capitalised on, and of the potential for person-centred communication interventions to achieve this. Further research needs to be embedded in real-world LDCT lung cancer screening services and use condition-specific measures to monitor outcomes and test evidence-based communication interventions in promoting psychological well-being.
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Affiliation(s)
- Samantha L. Quaife
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Samuel M. Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, UK
| | - Kate E. Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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23
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Dawes P, Munro KJ, Frank TL, Moore DR, Armitage C, Marsden A, Lees J, Dillon H. Uptake of internet-delivered UK adult hearing assessment. Int J Audiol 2021; 60:885-889. [PMID: 33820477 DOI: 10.1080/14992027.2021.1886353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate uptake of the internet-based hearing test, with respect to the 11% of UK adults that have hearing loss but do not use hearing aids. DESIGN Feasibility study in a primary care practice in the North of England. STUDY SAMPLE Adults aged 50-74 years were sent postal invitations to complete an internet hearing test (N = 600). Those who completed the test, those who failed (>35 dB HL in the better ear) and demographic correlates (age, gender, ethnicity and socioeconomic level) were recorded. RESULTS 11.2% of invited adults completed the hearing test and 7.7% failed it. Those who took the test tended to have a higher socioeconomic background than those who did not. There were no differences in age, ethnicity or gender between those who took the test and those who did not. CONCLUSIONS An estimated 70% (7.7%/11.0%) of adults with hearing loss but who do not use hearing aids took the test. Uptake was equitable across most demographic categories. Uptake was high among a study sample that was substantially more deprived than the general UK population. Internet-based hearing testing offers an efficient paradigm for identifying hearing loss.
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Affiliation(s)
- Piers Dawes
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust (MFT), Manchester, UK.,Department of Linguistics, Macquarie University, Sydney, Australia
| | - Kevin J Munro
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust (MFT), Manchester, UK
| | - Timothy L Frank
- Manchester Academic Health Science Centre, University Hospital South Manchester NHS Foundation Trust, Manchester, UK.,NIHR South Manchester Respiratory and Allergy Clinical Research Facility, Manchester, UK
| | - David R Moore
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust (MFT), Manchester, UK.,Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Chris Armitage
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust (MFT), Manchester, UK.,Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
| | - Antonia Marsden
- Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jane Lees
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, UK
| | - Harvey Dillon
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust (MFT), Manchester, UK.,Department of Linguistics, Macquarie University, Sydney, Australia
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24
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Tringali G, Milanese G, Ledda RE, Pastorino U, Sverzellati N, Silva M. Lung Cancer Screening: Evidence, Risks, and Opportunities for Implementation. ROFO-FORTSCHR RONTG 2021; 193:1153-1161. [PMID: 33772489 DOI: 10.1055/a-1382-8648] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Lung cancer is the most common cause of cancer death worldwide. Several trials with different screening approaches have recognized the role of lung cancer screening with low-dose CT for reducing lung cancer mortality. The efficacy of lung cancer screening depends on many factors and implementation is still pending in most European countries. METHODS This review aims to portray current evidence on lung cancer screening with a focus on the potential for opportunities for implementation strategies. Pillars of lung cancer screening practice will be discussed according to the most updated literature (PubMed search until November 16, 2020). RESULTS AND CONCLUSION The NELSON trial showed reduction of lung cancer mortality, thus confirming previous results of independent European studies, notably by volume of lung nodules. Heterogeneity in patient recruitment could influence screening efficacy, hence the importance of risk models and community-based screening. Recruitment strategies develop and adapt continuously to address the specific needs of the heterogeneous population of potential participants, the most updated evidence comes from the UK. The future of lung cancer screening is a tailored approach with personalized continuous stratification of risk, aimed at reducing costs and risks. KEY POINTS · Secondary prevention of lung cancer by low-dose computed tomography showed a reduction of lung cancer mortality.. · Semi-automated volume measurement and use of volume doubling time should be the reference method for optimization of risks, namely controlling measurement variability and the false-positive rate.. · A conservative approach with surveillance of subsolid nodules can be one of the strategies to reduce the risk of overdiagnosis and overtreatment.. · The goal of a tailored approach with personalized risk stratification aims to reduce costs and risks. A longer interval between rounds is one option for participants at lower risk.. CITATION FORMAT · Tringali G, Milanese G, Ledda RE et al. Lung Cancer Screening: Evidence, Risks, and Opportunities for Implementation. Fortschr Röntgenstr 2021; 193: 1153 - 1161.
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Affiliation(s)
- Giulia Tringali
- Department of Medicine and Surgery (DiMeC - Scienze Radiologiche), University of Parma, Italy
| | - Gianluca Milanese
- Department of Medicine and Surgery (DiMeC - Scienze Radiologiche), University of Parma, Italy
| | - Roberta Eufrasia Ledda
- Department of Medicine and Surgery (DiMeC - Scienze Radiologiche), University of Parma, Italy
| | - Ugo Pastorino
- Department of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Nicola Sverzellati
- Department of Medicine and Surgery (DiMeC - Scienze Radiologiche), University of Parma, Italy
| | - Mario Silva
- Department of Medicine and Surgery (DiMeC - Scienze Radiologiche), University of Parma, Italy
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25
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Pinsky PF, Lau YK, Doubeni CA. Potential Disparities by Sex and Race or Ethnicity in Lung Cancer Screening Eligibility Rates. Chest 2021; 160:341-350. [PMID: 33545164 DOI: 10.1016/j.chest.2021.01.070] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/04/2021] [Accepted: 01/18/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Criteria for low-dose CT scan lung cancer screening vary across guidelines. Knowledge of the eligible pool across demographic groups can enable policy and programmatic decision-making, particularly for disproportionately affected populations. RESEARCH QUESTION What are the eligibility rates for low-dose CT scan screening according to sex and race or ethnicity and how do these rates relate to corresponding lung cancer incidence rates? STUDY DESIGN AND METHODS This was a cross-sectional study using data from the 2015 National Health Interview Survey adult and cancer control supplement files. In addition to eligibility rates, the ratio of the eligibility rate to the lung cancer incidence rate in a given population group (eligibility to incidence [E-I] ratio) also was determined. Guidelines assessed were: Centers for Medicare and Medicaid Services, National Comprehensive Cancer Network, and US Preventive Services Task Force current or with expansion of age and smoking or quit thresholds. We also assessed a risk model (PLCOM2012 risk model). RESULTS Total numbers eligible based on current guidelines ranged from 8.3 to 13.3 million, representing 8.3% to 13.4% of the US population 50 to 80 years of age, and up to 17.5 million with expanded criteria. Overall eligibility rates on average were about 10 percentage points higher for men than women. For both men and women, and both overall and among ever smokers, non-Hispanic Whites had the highest eligibility rates across all guidelines, followed generally by non-Hispanic Blacks, and then Asians and Hispanics. Among both men and women, non-Hispanic Whites had the highest E-I ratios across all guidelines; non-Hispanic Black men had higher lung cancer incidence, but 30% to 50% lower E-I ratios, than non-Hispanic White men. INTERPRETATION Screening eligibility rates vary widely across guidelines, with disparities evident in E-I ratios, including among non-Hispanic Black men, despite higher lung cancer burden. Consideration of smoking duration in risk assessment criteria may address current disparities.
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Affiliation(s)
- Paul F Pinsky
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD.
| | - Yan Kwan Lau
- Department of Family Medicine, Mayo Clinic, Rochester, MN
| | - Chyke A Doubeni
- Department of Family Medicine, Mayo Clinic, Rochester, MN; Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN
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26
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van der Aalst CM, Ten Haaf K, de Koning HJ. Implementation of lung cancer screening: what are the main issues? Transl Lung Cancer Res 2021; 10:1050-1063. [PMID: 33718044 PMCID: PMC7947387 DOI: 10.21037/tlcr-20-985] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Two large-scale RCTs have shown computed tomography (CT) lung cancer screening to be efficacious in reducing lung cancer mortality (8–24% in men, 26–59% in women). However, lung cancer screening implicitly means personalised and risk-based approaches. Health care systems’ implementation of personalised screening and prevention is still sparse, and likely to be of variable quality, because of important remaining uncertainties, which have been incompletely addressed or not at all so far. Further optimisation of lung cancer screening programs is expected to reduce harms and maintain or enhance benefit for eligible European citizens, whilst significantly reducing health care costs. Some main uncertainties (e.g., Risk-based eligibility, Risk-based screening intervals, Volume CT screening, Smoking Cessation, Gender and Sex differences, Cost-Effectiveness) are discussed in this review. 4-IN-THE-LUNG-RUN (acronym for: Towards INdividually tailored INvitations, screening INtervals and INtegrated co-morbidity reducing strategies in lung cancer screening) is the first multi-centred implementation trial on volume CT lung cancer screening amongst 24,000 males and females, at high risk for developing lung cancer, across five European countries, started in January 2020. Through providing answers to the remaining questions with this trial, many EU citizens will swiftly benefit from this high-quality screening technology, others will face less harms than previously anticipated, and health care costs will be substantially reduced. Implementing a new cancer screening programme is a major task, with many stakeholders and many possible facilitators but also barriers and obstacle.
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Affiliation(s)
- Carlijn M van der Aalst
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kevin Ten Haaf
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
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27
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Moldovanu D, de Koning HJ, van der Aalst CM. Lung cancer screening and smoking cessation efforts. Transl Lung Cancer Res 2021; 10:1099-1109. [PMID: 33718048 PMCID: PMC7947402 DOI: 10.21037/tlcr-20-899] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Randomized-controlled trials have confirmed substantial reductions in lung cancer mortality with low-dose computed tomography (LDCT) screening. Evidence on how to integrate smoking cessation support in lung cancer screening is however scarce. This represents a significant gap in the literature, as a combined strategy of lung cancer screening and smoking cessation greatly reduces the mortality risk due to lung cancer and other related comorbidities. In this review, a literature search in MEDLINE, Embase, Web of Science, the Cochrane Central Register of Controlled Trials and Google Scholar was performed to identify randomized-controlled and observational studies investigating the effect of lung cancer screening trials and integrated cessation interventions on smoking cessation. Of the 236 identified records, we included 32 original publications. Smoking cessation rates in lung cancer screening trials are promising. Especially findings suspicious for lung cancer and referral to a physician might function as a teachable moment to motivate smoking abstinence in current smokers or recent quitters. More intensive, personalized and multi-modality smoking cessation interventions delivered by a clinician appear to be the most successful in influencing smoking behavior. While it is evident that smoking cessation should be incorporated in lung cancer screening, further research is required to ascertain the optimal treatment type, modality, timing, and content of communication including the incorporation of CT results to motivate health behavior change.
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Affiliation(s)
- Dana Moldovanu
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Carlijn M van der Aalst
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
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28
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Abstract
Although there is now strong evidence for the efficacy of low-radiation dose computed tomography in reducing lung cancer mortality, the challenge is to establish screening programmes that have the maximum impact on the disease. In screening programmes, participation rates are a major determinant of the success of the programme. Informed uptake, participation, and adherence (to successive screening rounds) determine the overall impact of the intervention by ensuring the maximum number of people at risk of the disease are screened regularly and therefore have the most chance of benefiting. Existing cancer screening programmes have taught us a great deal about methods that improve participation. Although evidence is emerging for the efficacy of some of those methods in lung cancer screening, there is still much work to do in the specific demographic that is most at risk of lung cancer. This demographic, characterised by higher levels of socioeconomic deprivation, may be less willing to engage with healthcare interventions and present a particular challenge in the process of ensuring informed choice. In this article we review the evidence for improving participation and describe the challenges that need to be addressed to ensure the successful implementation of CT screening programmes.
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Affiliation(s)
- David R Baldwin
- Divison of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.,Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - Kate Brain
- Division of Population Medicine, Cardiff University, Heath Park, Cardiff, UK
| | - Samantha Quaife
- Department of Behavioural Science and Health, Institute of Epidemiology and Public Health, University College London, London, UK
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29
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Kummer S, Waller J, Ruparel M, Duffy SW, Janes SM, Quaife SL. Psychological outcomes of low-dose CT lung cancer screening in a multisite demonstration screening pilot: the Lung Screen Uptake Trial (LSUT). Thorax 2020; 75:1065-1073. [PMID: 33087548 PMCID: PMC7677470 DOI: 10.1136/thoraxjnl-2020-215054] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/07/2020] [Accepted: 09/18/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Previous studies of psychological burden in low-dose CT (LDCT) lung cancer screening trials may lack generalisability due to participation bias and control arms having elevated distress. METHODS Current and former smokers (n=787, aged 60-75) within a real-world screening demonstration pilot completed measures of lung cancer worry at three time points (T0: appointment, T1: next day, T2: 3 months) and anxiety and depression at two time points (T0 and T2). A 'screening unaware' community sample (n=383) with the same age and smoking characteristics completed these measures once (T0). Mean scores were compared by sample type and LDCT result. RESULTS Compared with the community sample (T0), mean scores were higher in the screening sample, and statistically significantly increased in adjusted analyses, for lung cancer worry at T0 and T2 (mean (M): 9.32; 95% CI 8.96 to 9.69 vs M: 11.34; 11.09 to 11.59 and M: 11.88; 11.49 to 12.27), for anxiety at T0 and T2 (M: 3.32; 2.94 to 3.70 vs M: 4.73; 4.42 to 5.04 and M: 5.78; 5.33 to 6.23) and depression at T2 (M: 3.85; 3.44 to 4.27 vs M: 4.15; 3.76 to 4.55). Scores were highest for those with indeterminate (eg, T2 anxiety M: 6.93; 5.65 to 8.21) and incidental findings (primary care follow-up M: 5.34; 4.67 to 6.02) and those ineligible for screening (M: 6.51; 5.25 to 7.77). Being female, younger, not in paid employment, not married/cohabiting with a partner and lower education predicted poorer psychological outcomes at T0, but not T2 after adjusting for baseline scores. Mean scores remained within 'normal' clinical ranges. CONCLUSION Psychological distress was raised among high-risk individuals undergoing LDCT screening in a real-world setting, but overall differences were unlikely to be clinically meaningful. It will be critical to monitor the psychological impact of services longitudinally across diverse settings, including subgroups vulnerable to clinically elevated distress. TRIAL REGISTRATION The Lung Screen Uptake Trial was registered prospectively with the International Standard Registered Clinical/soCial sTudy (ISRCTN) (Number: ISRCTN21774741) on 23 September 2015 and the National Institutes of Health ClinicalTrials.gov database (NCT02558101) on 22 September 2015.
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Affiliation(s)
- Sonja Kummer
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Jo Waller
- Research Department of Behavioural Science and Health, University College London, London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, UK
| | - Stephen W Duffy
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Samuel M Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, UK
| | - Samantha L Quaife
- Research Department of Behavioural Science and Health, University College London, London, UK
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30
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Commonly Applied Selection Criteria for Lung Cancer Screening May Have Strongly Varying Diagnostic Performance in Different Countries. Cancers (Basel) 2020; 12:cancers12103012. [PMID: 33081402 PMCID: PMC7602978 DOI: 10.3390/cancers12103012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/05/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Smoking causes the majority of lung cancers. Smoking history is thus used to select individuals among whom screening for lung cancer could be the most beneficial. The aim of our study was to estimate sensitivity and specificity of pre-selection by heavy smoking in individual European countries. Due to differences in smoking histories across the countries and sexes within the countries, the sensitivities were found to be between 33 and 80% for men and between 9 and 79% for women. Corresponding specificities of heavy smoking varied between 48 and 90% (men) and 70 and 99% (women). Our results may inform the design of lung cancer screening programs in European countries and serve as benchmarks for novel alternative or complementary tests for selecting people at high risk for computed tomography-based lung cancer screening. Abstract Lung cancer (LC) screening often focuses heavy smokers as a target for screening group. Heavy smoking can thus be regarded as an LC pre-screening test with sensitivities and specificities being different in various populations due to the differences in smoking histories. We derive here expected sensitivities and specificities of various criteria to preselect individuals for LC screening in 27 European countries with diverse smoking prevalences. Sensitivities of various heavy-smoking-based pre-screening criteria were estimated by combining sex-specific proportions of people meeting these criteria in the target population for screening with associations of heavy smoking with LC risk. Expected specificities were approximated by the proportion of individuals not meeting the heavy smoking definition. Estimated sensitivities and specificities varied widely across countries, with sensitivities being generally higher among men (range: 33–80%) than among women (range: 9–79%), and specificities being generally lower among men (range: 48–90%) than among women (range: 70–99%). Major variation in sensitivities and specificities was also seen across different pre-selection criteria for LC screening within individual countries. Our results may inform the design of LC screening programs in European countries and serve as benchmarks for novel alternative or complementary tests for selecting people at high risk for CT-based LC screening.
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31
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Lung cancer LDCT screening and mortality reduction - evidence, pitfalls and future perspectives. Nat Rev Clin Oncol 2020; 18:135-151. [PMID: 33046839 DOI: 10.1038/s41571-020-00432-6] [Citation(s) in RCA: 204] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 12/17/2022]
Abstract
In the past decade, the introduction of molecularly targeted agents and immune-checkpoint inhibitors has led to improved survival outcomes for patients with advanced-stage lung cancer; however, this disease remains the leading cause of cancer-related mortality worldwide. Two large randomized controlled trials of low-dose CT (LDCT)-based lung cancer screening in high-risk populations - the US National Lung Screening Trial (NLST) and NELSON - have provided evidence of a statistically significant mortality reduction in patients. LDCT-based screening programmes for individuals at a high risk of lung cancer have already been implemented in the USA. Furthermore, implementation programmes are currently underway in the UK following the success of the UK Lung Cancer Screening (UKLS) trial, which included the Liverpool Health Lung Project, Manchester Lung Health Check, the Lung Screen Uptake Trial, the West London Lung Cancer Screening pilot and the Yorkshire Lung Screening trial. In this Review, we focus on the current evidence on LDCT-based lung cancer screening and discuss the clinical developments in high-risk populations worldwide; additionally, we address aspects such as cost-effectiveness. We present a framework to define the scope of future implementation research on lung cancer screening programmes referred to as Screening Planning and Implementation RAtionale for Lung cancer (SPIRAL).
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32
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Raju S, Khawaja A, Han X, Wang X, Mazzone PJ. Lung Cancer Screening: Characteristics of Nonparticipants and Potential Screening Barriers. Clin Lung Cancer 2020; 21:e329-e336. [DOI: 10.1016/j.cllc.2019.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/11/2019] [Accepted: 11/22/2019] [Indexed: 10/24/2022]
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33
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Bartlett EC, Kemp SV, Ridge CA, Desai SR, Mirsadraee S, Morjaria JB, Shah PL, Popat S, Nicholson AG, Rice AJ, Jordan S, Begum S, Mani A, Derbyshire J, Morris K, Chen M, Peacock C, Addis J, Martins M, Kaye SB, Padley SPG, Devaraj A. Baseline Results of the West London lung cancer screening pilot study - Impact of mobile scanners and dual risk model utilisation. Lung Cancer 2020; 148:12-19. [PMID: 32771715 DOI: 10.1016/j.lungcan.2020.07.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/15/2020] [Accepted: 07/24/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The West London lung screening pilot aimed to identify early-stage lung cancer by targeting low-dose CT (LDCT) to high risk participants. Successful implementation of screening requires maximising participant uptake and identifying those at highest risk. As well as reporting pre-specified baseline screening metrics, additional objectives were to 1) compare participant uptake between a mobile and hospital-based CT scanner and 2) evaluate the impact on cancer detection using two lung cancer risk models. METHODS From primary care records, ever-smokers aged 60-75 were invited to a lung health check at a hospital or mobile site. Participants with PLCOM2012 6-yr risk ≥1.51 % and/or LLPv2 5-yr risk ≥2.0 % were offered a LDCT. Lung cancer detection rate, stage, and recall rates are reported. Participant uptake was compared at both sites (chi-squared test). LDCT eligibility and cancer detection rate were compared between those recruited under each risk model. RESULTS Of 8366 potential participants invited, 1047/5135 (20.4 %) invitees responded to an invitation to the hospital site, and 702/3231 (21.7 %) to the mobile site (p = 0.14). The median distance travelled to the hospital site was less than to the mobile site (3.3 km vs 6.4 km, p < 0.01). Of 1159 participants eligible for a scan, 451/1159 (38.9 %) had a LLPv2 ≥2.0 % only, 71/1159 (6.1 %) had a PLCOM2012 ≥1.5 % only; 637/1159 (55.0 %) met both risk thresholds. Recall rate was 15.9 %. Lung cancer was detected in 29/1145 (2.5 %) participants scanned (stage 1, 58.6 %); 5/29 participants with lung cancer did not meet a PLCOM2012 threshold of ≥1.51 %; all had a LLPv2 ≥2.0 %. CONCLUSION Targeted screening is effective in detecting early-stage lung cancer. Similar levels of participant uptake at a mobile and fixed site scanner were demonstrated, indicating that uptake was driven by factors in addition to scanner location. The LLPv2 model was more permissive; recruitment with PLCOM2012 alone would have missed several cancers.
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Affiliation(s)
- Emily C Bartlett
- Royal Brompton and Harefield NHS Foundation Trust, Department of Radiology, Sydney Street, London, SW3 6NP, UK
| | - Samuel V Kemp
- Royal Brompton and Harefield NHS Foundation Trust, Department of Respiratory Medicine, Sydney Street, London, SW3 6NP, UK; National Heart and Lung Institute, Imperial College, London, SW3 6LY, UK
| | - Carole A Ridge
- Royal Brompton and Harefield NHS Foundation Trust, Department of Radiology, Sydney Street, London, SW3 6NP, UK
| | - Sujal R Desai
- Royal Brompton and Harefield NHS Foundation Trust, Department of Radiology, Sydney Street, London, SW3 6NP, UK; National Heart and Lung Institute, Imperial College, London, SW3 6LY, UK
| | - Saeed Mirsadraee
- Royal Brompton and Harefield NHS Foundation Trust, Department of Radiology, Sydney Street, London, SW3 6NP, UK; National Heart and Lung Institute, Imperial College, London, SW3 6LY, UK
| | - Jaymin B Morjaria
- Royal Brompton and Harefield NHS Foundation Trust, Department of Respiratory Medicine, Harefield Hospital, Hill End Road, Harefield, UB9 6JH, UK
| | - Pallav L Shah
- Royal Brompton and Harefield NHS Foundation Trust, Department of Respiratory Medicine, Sydney Street, London, SW3 6NP, UK; National Heart and Lung Institute, Imperial College, London, SW3 6LY, UK
| | - Sanjay Popat
- National Heart and Lung Institute, Imperial College, London, SW3 6LY, UK; Lung Unit, Royal Marsden Hospital, Fulham Road, London, SW6 3JJ, UK; Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
| | - Andrew G Nicholson
- National Heart and Lung Institute, Imperial College, London, SW3 6LY, UK; Royal Brompton and Harefield NHS Foundation Trust, Department of Histopathology, Sydney Street, London, SW3 6NP, UK
| | - Alexandra J Rice
- Royal Brompton and Harefield NHS Foundation Trust, Department of Histopathology, Sydney Street, London, SW3 6NP, UK
| | - Simon Jordan
- Royal Brompton and Harefield NHS Foundation Trust, Department of Thoracic Surgery, Sydney Street, London, SW3 6NP, UK
| | - Sofina Begum
- Royal Brompton and Harefield NHS Foundation Trust, Department of Thoracic Surgery, Sydney Street, London, SW3 6NP, UK
| | - Aleksander Mani
- Royal Brompton and Harefield NHS Foundation Trust, Department of Thoracic Surgery, Sydney Street, London, SW3 6NP, UK
| | - Jane Derbyshire
- RM Partners, The West London Cancer Alliance, 5th Floor, Alliance House, 12 Caxton Street, London, SW1H 0QS, UK
| | - Katie Morris
- RM Partners, The West London Cancer Alliance, 5th Floor, Alliance House, 12 Caxton Street, London, SW1H 0QS, UK
| | - Michelle Chen
- RM Partners, The West London Cancer Alliance, 5th Floor, Alliance House, 12 Caxton Street, London, SW1H 0QS, UK
| | - Christine Peacock
- Royal Brompton and Harefield NHS Foundation Trust, Department of Radiology, Sydney Street, London, SW3 6NP, UK
| | - James Addis
- Royal Brompton and Harefield NHS Foundation Trust, Department of Radiology, Sydney Street, London, SW3 6NP, UK
| | - Maria Martins
- Respiratory Biomedical Research Unit, Royal Brompton Hospital and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
| | - Stan B Kaye
- RM Partners, Sycamore House, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK
| | - Simon P G Padley
- Royal Brompton and Harefield NHS Foundation Trust, Department of Radiology, Sydney Street, London, SW3 6NP, UK; National Heart and Lung Institute, Imperial College, London, SW3 6LY, UK
| | - Anand Devaraj
- Royal Brompton and Harefield NHS Foundation Trust, Department of Radiology, Sydney Street, London, SW3 6NP, UK; National Heart and Lung Institute, Imperial College, London, SW3 6LY, UK.
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Clark ME, Young B, Bedford LE, das Nair R, Robertson JFR, Vedhara K, Sullivan F, Mair FS, Schembri S, Littleford RC, Kendrick D. Lung cancer screening: does pulmonary nodule detection affect a range of smoking behaviours? J Public Health (Oxf) 2020; 41:600-608. [PMID: 30272192 DOI: 10.1093/pubmed/fdy158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 07/09/2018] [Accepted: 08/24/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Lung cancer screening can reduce lung cancer mortality by 20%. Screen-detected abnormalities may provide teachable moments for smoking cessation. This study assesses impact of pulmonary nodule detection on smoking behaviours within the first UK trial of a novel auto-antibody test, followed by chest x-ray and serial CT scanning for early detection of lung cancer (Early Cancer Detection Test-Lung Cancer Scotland Study). METHODS Test-positive participants completed questionnaires on smoking behaviours at baseline, 1, 3 and 6 months. Logistic regression compared outcomes between nodule (n = 95) and normal CT groups (n = 174) at 3 and 6 months follow-up. RESULTS No significant differences were found between the nodule and normal CT groups for any smoking behaviours and odds ratios comparing the nodule and normal CT groups did not vary significantly between 3 and 6 months. There was some evidence the nodule group were more likely to report significant others wanted them to stop smoking than the normal CT group (OR across 3- and 6-month time points: 3.04, 95% CI: 0.95, 9.73; P = 0.06). CONCLUSION Pulmonary nodule detection during lung cancer screening has little impact on smoking behaviours. Further work should explore whether lung cancer screening can impact on perceived social pressure and promote smoking cessation.
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Affiliation(s)
- Marcia E Clark
- Division of Primary Care, Floor 13, Tower Building, University Park, University of Nottingham, Nottingham, UK
| | - Ben Young
- Division of Primary Care, Floor 13, Tower Building, University Park, University of Nottingham, Nottingham, UK
| | - Laura E Bedford
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, Northern Ireland
| | - Roshan das Nair
- Institute of Mental Health, Jubilee Campus, University of Nottingham, Nottingham, UK
| | - John F R Robertson
- Faculty of Medicine and Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Kavita Vedhara
- Division of Primary Care, Floor 13, Tower Building, University Park, University of Nottingham, Nottingham, UK
| | - Francis Sullivan
- School of Medicine, University of St Andrews, North Haugh, St Andrews, UK
| | - Frances S Mair
- Head of General Practice and Primary Care, Institute of Health and Wellbeing, MVLS, University of Glasgow, 1 Horselethill Road, Glasgow, UK
| | - Stuart Schembri
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Roberta C Littleford
- Tayside Clinical Trials Unit (TCTU), Tayside Medical Science Centre (TASC), University of Dundee, School of Medicine, Ninewells Hospital and Medical School, Residency Block, Level 3, George Pirie Way, Dundee, UK
| | - Denise Kendrick
- Division of Primary Care, Floor 13, Tower Building, University Park, University of Nottingham, Nottingham, UK
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Veronesi G, Baldwin DR, Henschke CI, Ghislandi S, Iavicoli S, Oudkerk M, De Koning HJ, Shemesh J, Field JK, Zulueta JJ, Horgan D, Fiestas Navarrete L, Infante MV, Novellis P, Murray RL, Peled N, Rampinelli C, Rocco G, Rzyman W, Scagliotti GV, Tammemagi MC, Bertolaccini L, Triphuridet N, Yip R, Rossi A, Senan S, Ferrante G, Brain K, van der Aalst C, Bonomo L, Consonni D, Van Meerbeeck JP, Maisonneuve P, Novello S, Devaraj A, Saghir Z, Pelosi G. Recommendations for Implementing Lung Cancer Screening with Low-Dose Computed Tomography in Europe. Cancers (Basel) 2020; 12:E1672. [PMID: 32599792 PMCID: PMC7352874 DOI: 10.3390/cancers12061672] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022] Open
Abstract
Lung cancer screening (LCS) with low-dose computed tomography (LDCT) was demonstrated in the National Lung Screening Trial (NLST) to reduce mortality from the disease. European mortality data has recently become available from the Nelson randomised controlled trial, which confirmed lung cancer mortality reductions by 26% in men and 39-61% in women. Recent studies in Europe and the USA also showed positive results in screening workers exposed to asbestos. All European experts attending the "Initiative for European Lung Screening (IELS)"-a large international group of physicians and other experts concerned with lung cancer-agreed that LDCT-LCS should be implemented in Europe. However, the economic impact of LDCT-LCS and guidelines for its effective and safe implementation still need to be formulated. To this purpose, the IELS was asked to prepare recommendations to implement LCS and examine outstanding issues. A subgroup carried out a comprehensive literature review on LDCT-LCS and presented findings at a meeting held in Milan in November 2018. The present recommendations reflect that consensus was reached.
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Affiliation(s)
- Giulia Veronesi
- Faculty of Medicine and Surgery—Vita-Salute San Raffaele University, 20132 Milan, Italy;
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - David R. Baldwin
- Department of Respiratory Medicine, David Evans Research Centre, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK;
| | - Claudia I. Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.I.H.); (N.T.); (R.Y.)
| | - Simone Ghislandi
- Department of Social and Political Sciences, Bocconi University, 20136 Milan, Italy; (S.G.); (L.F.N.)
| | - Sergio Iavicoli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers’ Compensation Authority (INAIL), 00078 Rome, Italy;
| | - Matthijs Oudkerk
- Center for Medical Imaging, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands;
| | - Harry J. De Koning
- Department of Public Health, Erasmus MC—University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (H.J.D.K.); (C.v.d.A.)
| | - Joseph Shemesh
- The Grace Ballas Cardiac Research Unit, Sheba Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, 52621 Tel Aviv-Yafo, Israel;
| | - John K. Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, Liverpool L69 3BX, UK;
| | - Javier J. Zulueta
- Department of Pulmonology, Clinica Universidad de Navarra, 31008 Pamplona, Spain;
- Visiongate Inc., Phoenix, AZ 85044, USA
| | - Denis Horgan
- European Alliance for Personalised Medicine (EAPM), Avenue de l’Armée Legerlaan 10, 1040 Brussels, Belgium;
| | - Lucia Fiestas Navarrete
- Department of Social and Political Sciences, Bocconi University, 20136 Milan, Italy; (S.G.); (L.F.N.)
| | | | - Pierluigi Novellis
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Rachael L. Murray
- Division of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies, Clinical Sciences Building, City Hospital, University of Nottingham, Nottingham NG5 1PB, UK;
| | - Nir Peled
- The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, 84101 Beer-Sheva, Israel;
| | - Cristiano Rampinelli
- Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Gaetano Rocco
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Witold Rzyman
- Department of Thoracic Surgery, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | | | - Martin C. Tammemagi
- Department of Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St Catharines, ON L2S 3A1, Canada;
| | - Luca Bertolaccini
- Division of Thoracic Surgery, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Natthaya Triphuridet
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.I.H.); (N.T.); (R.Y.)
- Faculty of Medicine and Public Health, Chulabhorn Royal Academy, HRH Princess Chulabhorn College of Medical Science, Bangkok 10210, Thailand
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.I.H.); (N.T.); (R.Y.)
| | - Alexia Rossi
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele (MI), Italy;
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, VU location, De Boelelaan 1117, Postbox 7057, 1007 MB Amsterdam, The Netherlands;
| | - Giuseppe Ferrante
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center IRCCS, 20089 Rozzano (MI), Italy;
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff CF14 4YS, UK;
| | - Carlijn van der Aalst
- Department of Public Health, Erasmus MC—University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (H.J.D.K.); (C.v.d.A.)
| | - Lorenzo Bonomo
- Department of Bioimaging and Radiological Sciences, Catholic University, 00168 Rome, Italy;
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Jan P. Van Meerbeeck
- Thoracic Oncology, Antwerp University Hospital and Ghent University, 2650 Edegem, Belgium;
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Silvia Novello
- Department of Oncology, University of Torino, 10124 Torino, Italy; (G.V.S.); (S.N.)
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London SW3 6NP, UK;
| | - Zaigham Saghir
- Department of Respiratory Medicine, Herlev-Gentofte University Hospital, 2900 Hellerup, Denmark;
| | - Giuseppe Pelosi
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Inter-Hospital Pathology Division, IRCCS MultiMedica, 20138 Milan, Italy
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Recommendations for Implementing Lung Cancer Screening with Low-Dose Computed Tomography in Europe. Cancers (Basel) 2020; 12:0. [PMID: 32599792 PMCID: PMC7352874 DOI: 10.3390/cancers12060000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Lung cancer screening (LCS) with low-dose computed tomography (LDCT) was demonstrated in the National Lung Screening Trial (NLST) to reduce mortality from the disease. European mortality data has recently become available from the Nelson randomised controlled trial, which confirmed lung cancer mortality reductions by 26% in men and 39-61% in women. Recent studies in Europe and the USA also showed positive results in screening workers exposed to asbestos. All European experts attending the "Initiative for European Lung Screening (IELS)"-a large international group of physicians and other experts concerned with lung cancer-agreed that LDCT-LCS should be implemented in Europe. However, the economic impact of LDCT-LCS and guidelines for its effective and safe implementation still need to be formulated. To this purpose, the IELS was asked to prepare recommendations to implement LCS and examine outstanding issues. A subgroup carried out a comprehensive literature review on LDCT-LCS and presented findings at a meeting held in Milan in November 2018. The present recommendations reflect that consensus was reached.
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Balata H, Harvey J, Barber PV, Colligan D, Duerden R, Elton P, Evison M, Greaves M, Howells J, Irion K, Karunaratne D, Mellor S, Newton T, Sawyer R, Sharman A, Smith E, Taylor B, Taylor S, Tonge J, Walsham A, Whittaker J, Vestbo J, Booton R, Crosbie PA. Spirometry performed as part of the Manchester community-based lung cancer screening programme detects a high prevalence of airflow obstruction in individuals without a prior diagnosis of COPD. Thorax 2020; 75:655-660. [DOI: 10.1136/thoraxjnl-2019-213584] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 12/21/2022]
Abstract
BackgroundCOPD is a major cause of morbidity and mortality in populations eligible for lung cancer screening. We investigated the role of spirometry in a community-based lung cancer screening programme.MethodsEver smokers, age 55–74, resident in three deprived areas of Manchester were invited to a ‘Lung Health Check’ (LHC) based in convenient community locations. Spirometry was incorporated into the LHCs alongside lung cancer risk estimation (Prostate, Lung, Colorectal and Ovarian Study Risk Prediction Model, 2012 version (PLCOM2012)), symptom assessment and smoking cessation advice. Those at high risk of lung cancer (PLCOM2012 ≥1.51%) were eligible for annual low-dose CT screening over two screening rounds. Airflow obstruction was defined as FEV1/FVC<0.7. Primary care databases were searched for any prior diagnosis of COPD.Results99.4% (n=2525) of LHC attendees successfully performed spirometry; mean age was 64.1±5.5, 51% were women, 35% were current smokers. 37.4% (n=944) had airflow obstruction of which 49.7% (n=469) had no previous diagnosis of COPD. 53.3% of those without a prior diagnosis were symptomatic (n=250/469). After multivariate analysis, the detection of airflow obstruction without a prior COPD diagnosis was associated with male sex (adjOR 1.84, 95% CI 1.37 to 2.47; p<0.0001), younger age (p=0.015), lower smoking duration (p<0.0001), fewer cigarettes per day (p=0.035), higher FEV1/FVC ratio (<0.0001) and being asymptomatic (adjOR 4.19, 95% CI 2.95 to 5.95; p<0.0001). The likelihood of screen detected lung cancer was significantly greater in those with evidence of airflow obstruction who had a previous diagnosis of COPD (adjOR 2.80, 95% CI 1.60 to 8.42; p=0.002).ConclusionsIncorporating spirometry into a community-based targeted lung cancer screening programme is feasible and identifies a significant number of individuals with airflow obstruction who do not have a prior diagnosis of COPD.
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Quaife SL, Ruparel M, Dickson JL, Beeken RJ, McEwen A, Baldwin DR, Bhowmik A, Navani N, Sennett K, Duffy SW, Wardle J, Waller J, Janes SM. Lung Screen Uptake Trial (LSUT): Randomized Controlled Clinical Trial Testing Targeted Invitation Materials. Am J Respir Crit Care Med 2020; 201:965-975. [PMID: 31825647 PMCID: PMC7159423 DOI: 10.1164/rccm.201905-0946oc] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 12/10/2019] [Indexed: 12/25/2022] Open
Abstract
Rationale: Low uptake of low-dose computed tomography (LDCT) lung cancer screening, particularly by current smokers of a low socioeconomic position, compromises effectiveness and equity.Objectives: To compare the effect of a targeted, low-burden, and stepped invitation strategy versus control on uptake of hospital-based Lung Health Check appointments offering LDCT screening.Methods: In a two-arm, blinded, between-subjects, randomized controlled trial, 2,012 participants were selected from 16 primary care practices using these criteria: 1) aged 60 to 75 years, 2) recorded as a current smoker within the last 7 years, and 3) no prespecified exclusion criteria contraindicating LDCT screening. Both groups received a stepped sequence of preinvitation, invitation, and reminder letters from their primary care practitioner offering prescheduled appointments. The key manipulation was the accompanying leaflet. The intervention group's leaflet targeted psychological barriers and provided low-burden information, mimicking the concept of the U.K. Ministry of Transport's annual vehicle test ("M.O.T. For Your Lungs").Measurements and Main Results: Uptake was 52.6%, with no difference between intervention (52.3%) and control (52.9%) groups in unadjusted (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.82-1.16) or adjusted (OR, 0.98; 95% CI, 0.82-1.17) analyses. Current smokers were less likely to attend (adjusted OR, 0.70; 95% CI, 0.56-0.86) than former smokers. Socioeconomic deprivation was significantly associated with lower uptake for the control group only (P < 0.01).Conclusions: The intervention did not improve uptake. Regardless of trial arm, uptake was considerably higher than previous clinical and real-world studies, particularly given that the samples were predominantly lower socioeconomic position smokers. Strategies common to both groups, including a Lung Health Check approach, could represent a minimum standard.Clinical trial registered with www.clinicaltrials.gov (NCT02558101) and registered prospectively with the International Standard Registered Clinical/Social Study (N21774741).
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Affiliation(s)
| | - Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Jennifer L. Dickson
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Rebecca J. Beeken
- Research Department of Behavioural Science and Health and
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Andy McEwen
- National Centre for Smoking Cessation and Training, Dorchester, United Kingdom
| | - David R. Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Angshu Bhowmik
- Department of Thoracic Medicine, Homerton University Hospital, London, United Kingdom
| | - Neal Navani
- Department of Thoracic Medicine, University College London Hospital, London, United Kingdom
| | - Karen Sennett
- Killick Street Health Centre, London, United Kingdom
| | - Stephen W. Duffy
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; and
| | - Jane Wardle
- Research Department of Behavioural Science and Health and
| | - Jo Waller
- Research Department of Behavioural Science and Health and
- School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Samuel M. Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
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Grover H, Ross T, Fuller E. Implementation of targeted screening for lung cancer in a high-risk population within routine NHS practice using low-dose computed tomography. Thorax 2020; 75:348-350. [PMID: 32127463 DOI: 10.1136/thoraxjnl-2019-214303] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/20/2019] [Accepted: 01/06/2020] [Indexed: 11/03/2022]
Abstract
We report a primary care-based lung cancer targeted screening programme using low-dose CT (LDCT) in South Tyneside and Sunderland. Ever smokers with ≥10 pack-years aged 55-74 years were identified at annual COPD review. 925 individuals attended for LDCT. 2% (n=19/925) had lung cancer diagnosed. 66.7% (n=14/21) had early stage disease and 78.9% (n=15/19) were offered treatment with curative intent. 79.3% of individuals attending for LDCT were ranked in the lowest deprivation quintiles. This approach has been successfully established in routine NHS practice; it is effective with improvements in stage of disease and engages individuals in deprived areas.
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Affiliation(s)
- Helen Grover
- Research and Development, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK .,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Thomas Ross
- Research and Development, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| | - Elizabeth Fuller
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Respiratory Medicine, South Tyneside District General Hospital, South Shields, UK
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Attending community-based lung cancer screening influences smoking behaviour in deprived populations. Lung Cancer 2020; 139:41-46. [DOI: 10.1016/j.lungcan.2019.10.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 10/24/2019] [Indexed: 11/23/2022]
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Wood DE, Kazerooni EA, Baum SL, Eapen GA, Ettinger DS, Hou L, Jackman DM, Klippenstein D, Kumar R, Lackner RP, Leard LE, Lennes IT, Leung ANC, Makani SS, Massion PP, Mazzone P, Merritt RE, Meyers BF, Midthun DE, Pipavath S, Pratt C, Reddy C, Reid ME, Rotter AJ, Sachs PB, Schabath MB, Schiebler ML, Tong BC, Travis WD, Wei B, Yang SC, Gregory KM, Hughes M. Lung Cancer Screening, Version 3.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 16:412-441. [PMID: 29632061 DOI: 10.6004/jnccn.2018.0020] [Citation(s) in RCA: 374] [Impact Index Per Article: 74.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lung cancer is the leading cause of cancer-related mortality in the United States and worldwide. Early detection of lung cancer is an important opportunity for decreasing mortality. Data support using low-dose computed tomography (LDCT) of the chest to screen select patients who are at high risk for lung cancer. Lung screening is covered under the Affordable Care Act for individuals with high-risk factors. The Centers for Medicare & Medicaid Services (CMS) covers annual screening LDCT for appropriate Medicare beneficiaries at high risk for lung cancer if they also receive counseling and participate in shared decision-making before screening. The complete version of the NCCN Guidelines for Lung Cancer Screening provides recommendations for initial and subsequent LDCT screening and provides more detail about LDCT screening. This manuscript focuses on identifying patients at high risk for lung cancer who are candidates for LDCT of the chest and on evaluating initial screening findings.
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Ghimire B, Maroni R, Vulkan D, Shah Z, Gaynor E, Timoney M, Jones L, Arvanitis R, Ledson M, Lukehirst L, Rutherford P, Clarke F, Gardner K, Marcus MW, Hill S, Fidoe D, Mason S, Smith SG, Quaife SL, Fitzgerald K, Poirier V, Duffy SW, Field JK. Evaluation of a health service adopting proactive approach to reduce high risk of lung cancer: The Liverpool Healthy Lung Programme. Lung Cancer 2019; 134:66-71. [PMID: 31319997 DOI: 10.1016/j.lungcan.2019.05.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/21/2019] [Accepted: 05/26/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This Liverpool Healthy Lung Programme is a response to high rates of lung cancer and respiratory diseases locally and aims to diagnose lung cancer at an earlier stage by proactive approach to those at high risk of lung cancer. The objective of this study is to evaluate the programme in terms of its likely effect on mortality from lung cancer and its delivery to deprived populations. METHODS Persons aged 58-75 years, with a history of smoking or a diagnosis of chronic obstructive pulmonary disease (COPD)2 according to general practice records were invited for lung health check in a community health hub setting. A detailed risk assessment and spirometry were performed in eligible patients. Those with a 5% or greater five-year risk of lung cancer were referred for a low dose CT3 scan. RESULTS A total of 4 566 subjects attended the appointment for risk assessment and 3 591 (79%) consented to data sharing. More than 80% of the patients were in the most deprived quintile of the index of multiple deprivation. Of those attending, 63% underwent spirometry and 43% were recommended for a CT scan. A total of 25 cancers were diagnosed, of which 16 (64%) were stage I. Comparison with the national stage distribution implied that the programme was reducing lung cancer mortality by 22%. CONCLUSIONS Community based proactive approaches to early diagnosis of lung cancer in health deprived regions are likely to be effective in early detection of lung cancer.
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Affiliation(s)
- Bhagabati Ghimire
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, UK.
| | - Roberta Maroni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, UK
| | - Daniel Vulkan
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, UK
| | - Zoheb Shah
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, UK
| | - Edward Gaynor
- National Health Service (NHS) Liverpool Clinical Commissioning Group, UK
| | - Michelle Timoney
- National Health Service (NHS) Liverpool Clinical Commissioning Group, UK
| | - Lisa Jones
- National Health Service (NHS) Liverpool Clinical Commissioning Group, UK
| | - Rachel Arvanitis
- National Health Service (NHS) Liverpool Clinical Commissioning Group, UK
| | | | | | | | | | - Katy Gardner
- Macmillan General Practitioner, NHS Liverpool Clinical Commissioning Group, UK
| | - Michael W Marcus
- Roy Castle Lung Cancer Research Programme, University of Liverpool Cancer Research Centre, UK
| | - Sarah Hill
- Roy Castle Lung Cancer Research Programme, University of Liverpool Cancer Research Centre, UK
| | - Darcy Fidoe
- Roy Castle Lung Cancer Research Programme, University of Liverpool Cancer Research Centre, UK
| | - Sabrina Mason
- Roy Castle Lung Cancer Research Programme, University of Liverpool Cancer Research Centre, UK
| | - Samuel G Smith
- Leeds Institute of Health Sciences, University of Leeds, UK
| | - Samantha L Quaife
- Research Department of Behavioural Science and Health, University College London, UK
| | - Karen Fitzgerald
- Accelerate, Coordinate, Evaluate (ACE) team, Cancer Research, UK
| | | | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, UK
| | - John K Field
- Roy Castle Lung Cancer Research Programme, University of Liverpool Cancer Research Centre, UK
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Balata H, Evison M, Sharman A, Crosbie P, Booton R. CT screening for lung cancer: Are we ready to implement in Europe? Lung Cancer 2019; 134:25-33. [PMID: 31319989 DOI: 10.1016/j.lungcan.2019.05.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/12/2019] [Accepted: 05/26/2019] [Indexed: 12/23/2022]
Abstract
Lung cancer screening with low-dose CT (LDCT) is already available in certain parts of the world, such as the United States, but not yet in Europe. The recently published European position statement on lung cancer screening has recommended planning for implementation of screening to start within 18-months [1]. Pilot European programmes are already underway, primarily in the United Kingdom (UK), delivering lung cancer screening to their local populations. This review article acknowledges the evidence base for LDCT screening and will discuss the challenges that still need to be overcome in an attempt to answer the question: are we ready to implement in Europe?
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Affiliation(s)
- Haval Balata
- Manchester Thoracic Oncology Centre (MTOC), North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK; Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health University of Manchester, Manchester, UK.
| | - Matthew Evison
- Manchester Thoracic Oncology Centre (MTOC), North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - Anna Sharman
- Manchester Thoracic Oncology Centre (MTOC), North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - Philip Crosbie
- Manchester Thoracic Oncology Centre (MTOC), North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Richard Booton
- Manchester Thoracic Oncology Centre (MTOC), North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
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Bravo-Iñiguez CE, Fox SW, De Leon LE, Tarascio JN, Jaklitsch MT, Jacobson FL. Cumulative nonsmoking risk factors increase the probability of developing lung cancer. J Thorac Cardiovasc Surg 2019; 158:1248-1254.e1. [PMID: 31248631 DOI: 10.1016/j.jtcvs.2019.04.098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 03/28/2019] [Accepted: 04/20/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND It is estimated that 20% of lung cancer cases in the United States are among never smokers, yet current screening recommendations only include a small subset of high-risk patients. In this study, 2 models were used to predict the risk of developing lung cancer in subgroups of never smoking patients with additional risk variables. METHODS The Liverpool Lung Project (LLP) and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) were 2 models used to calculate risk of developing lung cancer. Risk was calculated as a function of age for developing lung cancer within the next 5 to 10 years. RESULTS PLCO estimated a peak risk of 16.20% at age 75 for 30-pack-year smokers with a first-degree relative with lung cancer. LLP estimated a peak risk of 7.3% over the next 5 years at age 79 for men with 30-pack-year and a first-degree relative with early-onset lung cancer (<60 years). Female never smokers with cumulative variables other than smoking had a peak risk of 3.40% for age 74 to 75 years. In contrast, women with only 30-pack-year smoking history and no other variable had a peak risk of 2.20% at age 74 to 75 years. CONCLUSIONS Models such as LLP and PLCO might be used to identify risk for patients who would otherwise not receive lung cancer screening. These individual risk assessments can be used by patients and providers to assess if one is at substantial risk for developing lung cancer.
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Affiliation(s)
- Carlos E Bravo-Iñiguez
- Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
| | - Sam W Fox
- Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Luis E De Leon
- Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Jeffrey N Tarascio
- Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Michael T Jaklitsch
- Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Francine L Jacobson
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
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Marcus MW, Duffy SW, Devaraj A, Green BA, Oudkerk M, Baldwin D, Field J. Probability of cancer in lung nodules using sequential volumetric screening up to 12 months: the UKLS trial. Thorax 2019; 74:761-767. [PMID: 31028232 DOI: 10.1136/thoraxjnl-2018-212263] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 01/06/2019] [Accepted: 02/11/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Estimation of the clinical probability of malignancy in patients with pulmonary nodules will facilitate early diagnosis, determine optimum patient management strategies and reduce overall costs. METHODS Data from the UK Lung Cancer Screening trial were analysed. Multivariable logistic regression models were used to identify independent predictors and to develop a parsimonious model to estimate the probability of lung cancer in lung nodules detected at baseline and at 3-month and 12-month repeat screening. RESULTS Of 1994 participants who underwent CT scan, 1013 participants had a total of 5063 lung nodules and 52 (2.6%) of the participants developed lung cancer during a median follow-up of 4 years. Covariates that predict lung cancer in our model included female gender, asthma, bronchitis, asbestos exposure, history of cancer, early and late onset of family history of lung cancer, smoking duration, FVC, nodule type (pure ground-glass and part-solid) and volume as measured by semiautomated volumetry. The final model incorporating all predictors had excellent discrimination: area under the receiver operating characteristic curve (AUC 0.885, 95% CI 0.880 to 0.889). Internal validation suggested that the model will discriminate well when applied to new data (optimism-corrected AUC 0.882, 95% CI 0.848 to 0.907). The risk model had a good calibration (goodness-of-fit χ[8] 8.13, p=0.42). CONCLUSIONS Our model may be used in estimating the probability of lung cancer in nodules detected at baseline and at 3 months and 12 months from baseline, allowing more efficient stratification of follow-up in population-based lung cancer screening programmes. TRIAL REGISTRATION NUMBER 78513845.
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Affiliation(s)
- Michael W Marcus
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Stephen W Duffy
- Barts and London, Wolfson Institute of Preventive Medicine, London, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital London, London, UK
| | - Beverley A Green
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Matthijs Oudkerk
- Center for Medical Imaging (CMI), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - John Field
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
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Crosbie PA, Balata H, Evison M, Atack M, Bayliss-Brideaux V, Colligan D, Duerden R, Eaglesfield J, Edwards T, Elton P, Foster J, Greaves M, Hayler G, Higgins C, Howells J, Irion K, Karunaratne D, Kelly J, King Z, Manson S, Mellor S, Miller D, Myerscough A, Newton T, O'Leary M, Pearson R, Pickford J, Sawyer R, Screaton NJ, Sharman A, Simmons M, Smith E, Taylor B, Taylor S, Walsham A, Watts A, Whittaker J, Yarnell L, Threlfall A, Barber PV, Tonge J, Booton R. Implementing lung cancer screening: baseline results from a community-based 'Lung Health Check' pilot in deprived areas of Manchester. Thorax 2019; 74:405-409. [PMID: 29440588 DOI: 10.1136/thoraxjnl-2017-211377] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/15/2018] [Accepted: 01/22/2018] [Indexed: 11/03/2022]
Abstract
We report baseline results of a community-based, targeted, low-dose CT (LDCT) lung cancer screening pilot in deprived areas of Manchester. Ever smokers, aged 55-74 years, were invited to 'lung health checks' (LHCs) next to local shopping centres, with immediate access to LDCT for those at high risk (6-year risk ≥1.51%, PLCOM2012 calculator). 75% of attendees (n=1893/2541) were ranked in the lowest deprivation quintile; 56% were high risk and of 1384 individuals screened, 3% (95% CI 2.3% to 4.1%) had lung cancer (80% early stage) of whom 65% had surgical resection. Taking lung cancer screening into communities, with an LHC approach, is effective and engages populations in deprived areas.
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Affiliation(s)
- Phil A Crosbie
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Molecular and Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Haval Balata
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Matthew Evison
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Melanie Atack
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Val Bayliss-Brideaux
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Denis Colligan
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Rebecca Duerden
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Josephine Eaglesfield
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Timothy Edwards
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter Elton
- Greater Manchester, Lancashire, South Cumbria Strategic Clinical Network, Manchester, UK
| | | | - Melanie Greaves
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Graham Hayler
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Coral Higgins
- Manchester Health and Care Commissioning, Manchester, UK
| | - John Howells
- Department of Radiology, Royal Preston Hospital, Preston, UK
| | - Klaus Irion
- Department of Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Devinda Karunaratne
- Department of Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jodie Kelly
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Zoe King
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Sarah Manson
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Stuart Mellor
- Department of Radiology, Royal Blackburn Hospital, Blackburn, UK
| | | | - Amanda Myerscough
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Tom Newton
- Department of Radiology, Royal Blackburn Hospital, Blackburn, UK
| | | | - Rachel Pearson
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | | | - Richard Sawyer
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Anna Sharman
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Maggi Simmons
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Elaine Smith
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ben Taylor
- Department of Radiology, Christie NHS Foundation Trust, Manchester, UK
| | - Sarah Taylor
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Anna Walsham
- Department of Radiology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Angela Watts
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - James Whittaker
- Department of Radiology, Stockport NHS Foundation Trust, Stockport, UK
| | - Laura Yarnell
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Anthony Threlfall
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Phil V Barber
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Janet Tonge
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Richard Booton
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Tonge JE, Atack M, Crosbie PA, Barber PV, Booton R, Colligan D. "To know or not to know…?" Push and pull in ever smokers lung screening uptake decision-making intentions. Health Expect 2019; 22:162-172. [PMID: 30289583 PMCID: PMC6433322 DOI: 10.1111/hex.12838] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In the United States, lung cancer screening aims to detect cancer early in nonsymptomatic current and former smokers. A lung screening pilot service in an area of high lung cancer incidence in the United Kingdom has been designed based on United States trial evidence. However, our understanding of acceptability and reasons for lung screening uptake or decline in a United Kingdom nontrial context are currently limited. OBJECTIVE To explore with ever smokers the acceptability of targeted lung screening and uptake decision-making intentions. DESIGN Qualitative study using semistructured focus groups and inductive thematic analysis to explore acceptability and uptake decision-making intentions with people of similar characteristics to lung screening eligible individuals. SETTING AND PARTICIPANTS Thirty-three participants (22 ex-smokers; 11 smokers) men and women, smokers and ex-smokers, aged 50-80 were recruited purposively from community and health settings in Manchester, England. RESULTS Lung screening was widely acceptable to participants. It was seen as offering reassurance about lung health or opportunity for early detection and treatment. Participant's desire to know about their lung health via screening was impacted by perceived benefits; emotions such as worry about a diagnosis and screening tests; practicalities such as accessibility; and smoking-related issues including perceptions of individual risk and smoking stigma. DISCUSSION Decision making was multifaceted with indications that current smokers faced higher participation barriers than ex-smokers. Reducing participation barriers through careful service design and provision of decision support information will be important in lung screening programmes to support informed consent and equitable uptake.
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Affiliation(s)
- Janet E. Tonge
- Macmillan Cancer Improvement PartnershipParkway Business CentreManchester Health and Care CommissioningManchesterUK
- Present address:
Leeds Institute of Health SciencesUniversity of LeedsUK
| | - Melanie Atack
- Macmillan Cancer Improvement PartnershipParkway Business CentreManchester Health and Care CommissioningManchesterUK
- Present address:
The Christie NHS Foundation TrustManchesterUK
| | - Phil A. Crosbie
- North West Lung Centre, Wythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
| | - Phil V. Barber
- North West Lung Centre, Wythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
| | - Richard Booton
- North West Lung Centre, Wythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
| | - Denis Colligan
- Macmillan Cancer Improvement PartnershipParkway Business CentreManchester Health and Care CommissioningManchesterUK
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Delva F, Laurent F, Paris C, Belacel M, Brochard P, Bylicki O, Chouaïd C, Clin B, Dewitte JD, Le Denmat V, Gehanno JF, Lacourt A, Margery J, Verdun-Esquer C, Mathoulin-Pélissier S, Pairon JC. LUCSO-1-French pilot study of LUng Cancer Screening with low-dose computed tomography in a smokers population exposed to Occupational lung carcinogens: study protocol. BMJ Open 2019; 9:e025026. [PMID: 30904859 PMCID: PMC6475342 DOI: 10.1136/bmjopen-2018-025026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Guidelines concerning the follow-up of subjects occupationally exposed to lung carcinogens, published in France in 2015, recommended the setting up of a trial of low-dose chest CT lung cancer screening in subjects at high risk of lung cancer. OBJECTIVE To evaluate the organisation of low-dose chest CT lung cancer screening in subjects occupationally exposed to lung carcinogens and at high risk of lung cancer. METHODS AND ANALYSIS This trial will be conducted in eight French departments by six specialised reference centres (SRCs) in occupational health. In view of the exploratory nature of this trial, it is proposed to test initially the feasibility and acceptability over the first 2 years in only two SRCs then in four other SRCs to evaluate the organisation. The target population is current or former smokers with more than 30 pack-years (who have quit smoking for less than 15 years), currently or previously exposed to International Agency for Research on Cancer group 1 lung carcinogens, and between the ages of 55 and 74 years. The trial will be conducted in the following steps: (1) identification of subjects by a screening invitation letter; (2) evaluation of occupational exposure to lung carcinogens; (3) evaluation of the lung cancer risk level and verification of eligibility; (4) screening procedure: annual chest CT scans performed by specialised centres and (5) follow-up of CT scan abnormalities. ETHICS AND DISSEMINATION This protocol study has been approved by the French Committee for the Protection of Persons. The results from this study will be submitted to peer-reviewed journals and reported at suitable national and international meetings. TRIAL REGISTRATION NUMBER NCT03562052; Pre-results.
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Affiliation(s)
- Fleur Delva
- Service de médecine du travail et de pathologies professionnelles, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- EPICENE, INSERM U1219, Bordeaux, France
| | - François Laurent
- Service de médecine du travail et de pathologies professionnelles, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | - Milia Belacel
- Centre Hospitalier Intercommunal de Creteil, Creteil, Île-de-France, France
| | | | - Olivier Bylicki
- Department of Pneumologie, Hopital d’Instruction des Armees Percy, Clamart, France
| | - Christos Chouaïd
- Centre Hospitalier Intercommunal de Creteil, Creteil, Île-de-France, France
| | | | | | | | | | | | - Jacques Margery
- Department of Pneumologie, Hopital d’Instruction des Armees Percy, Clamart, France
| | - Catherine Verdun-Esquer
- Service de médecine du travail et de pathologies professionnelles, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | - Jean-Claude Pairon
- Pneumologie et pathologie professionnelle, Centre Hospitalier Intercommunal de Créteil, Créteil Cedex, France
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49
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Cheng YI, Davies MPA, Liu D, Li W, Field JK. Implementation planning for lung cancer screening in China. PRECISION CLINICAL MEDICINE 2019; 2:13-44. [PMID: 35694700 PMCID: PMC8985785 DOI: 10.1093/pcmedi/pbz002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/19/2018] [Accepted: 12/24/2018] [Indexed: 02/05/2023] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths in China, with over 690 000 lung cancer deaths estimated in 2018. The mortality has increased about five-fold from the mid-1970s to the 2000s. Lung cancer low-dose computerized tomography (LDCT) screening in smokers was shown to improve survival in the US National Lung Screening Trial, and more recently in the European NELSON trial. However, although the predominant risk factor, smoking contributes to a lower fraction of lung cancers in China than in the UK and USA. Therefore, it is necessary to establish Chinese-specific screening strategies. There have been 23 associated programmes completed or still ongoing in China since the 1980s, mainly after 2000; and one has recently been planned. Generally, their entry criteria are not smoking-stringent. Most of the Chinese programmes have reported preliminary results only, which demonstrated a different high-risk subpopulation of lung cancer in China. Evidence concerning LDCT screening implementation is based on results of randomized controlled trials outside China. LDCT screening programmes combining tobacco control would produce more benefits. Population recruitment (e.g. risk-based selection), screening protocol, nodule management and cost-effectiveness are discussed in detail. In China, the high-risk subpopulation eligible for lung cancer screening has not as yet been confirmed, as all the risk parameters have not as yet been determined. Although evidence on best practice for implementation of lung cancer screening has been accumulating in other countries, further research in China is urgently required, as China is now facing a lung cancer epidemic.
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Affiliation(s)
- Yue I Cheng
- Lung Cancer Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, United Kingdom
| | - Michael P A Davies
- Lung Cancer Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, United Kingdom
| | - Dan Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - John K Field
- Lung Cancer Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, United Kingdom
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50
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Stevens C, Smith SG, Quaife SL, Vrinten C, Waller J, Beeken RJ. Interest in lifestyle advice at lung cancer screening: Determinants and preferences. Lung Cancer 2019; 128:1-5. [PMID: 30642439 PMCID: PMC6345624 DOI: 10.1016/j.lungcan.2018.11.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/23/2018] [Accepted: 11/26/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Lung cancer screening could be a 'teachable moment' for behaviour change. Little is known about how advice about smoking cessation, or other behavioural cancer risk factors, would be received in this setting. METHODS Using a population-based survey of 459 English adults (current smokers and recent quitters aged 50-75) we assessed willingness to receive lifestyle advice (about smoking, diet, weight, physical activity, alcohol consumption) at lung screening. Additional items assessed whether advice should be provided following abnormal screening results, the potential impact of advice on screening uptake, and preferred timing of advice. RESULTS Overall, 64% (n = 292) of participants were willing to receive lifestyle advice at lung screening. A greater proportion of participants were willing to receive advice in a scenario where results required further investigation (83%; p < 0.01). However, 14% indicated the provision of lifestyle advice would make them less willing to attend lung screening. Non-White ethnicity and greater cancer risk factor awareness were associated with willingness to receive advice (p < 0.05). Half of smokers (51%) were willing to receive cessation advice. There was also interest in advice about diet (47%), weight (43%), physical activity (32%), and alcohol consumption (17%) among people not meeting current recommendations for these behaviours. There was a preference for advice to be delivered at the screening appointment (38%, n = 108) over other time-points. CONCLUSIONS Lung screening may offer an opportunity to provide advice about behavioural cancer risk factors. Future work should consider how to deliver effective interventions in this setting to support behaviour change, without affecting screening uptake.
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Affiliation(s)
- Claire Stevens
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Samuel G Smith
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK; Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9NL, UK
| | - Samantha L Quaife
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Charlotte Vrinten
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Jo Waller
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Rebecca J Beeken
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK; Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9NL, UK.
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