Baseline Results of the West London lung cancer screening pilot study - Impact of mobile scanners and dual risk model utilisation

Emily C Bartlett; Samuel V Kemp; Carole A Ridge; Sujal R Desai; Saeed Mirsadraee; Jaymin B Morjaria; Pallav L Shah; Sanjay Popat; Andrew G Nicholson; Alexandra J Rice; Simon Jordan; Sofina Begum; Aleksander Mani; Jane Derbyshire; Katie Morris; Michelle Chen; Christine Peacock; James Addis; Maria Martins; Stan B Kaye; Simon P G Padley; Anand Devaraj; West London Lung Screening Collaboration Group

doi:10.1016/j.lungcan.2020.07.027

Baseline Results of the West London lung cancer screening pilot study - Impact of mobile scanners and dual risk model utilisation

Lung Cancer. 2020 Oct:148:12-19. doi: 10.1016/j.lungcan.2020.07.027. Epub 2020 Jul 31.

Authors

Emily C Bartlett¹, Samuel V Kemp², Carole A Ridge¹, Sujal R Desai³, Saeed Mirsadraee³, Jaymin B Morjaria⁴, Pallav L Shah², Sanjay Popat⁵, Andrew G Nicholson⁶, Alexandra J Rice⁷, Simon Jordan⁸, Sofina Begum⁸, Aleksander Mani⁸, Jane Derbyshire⁹, Katie Morris⁹, Michelle Chen⁹, Christine Peacock¹, James Addis¹, Maria Martins¹⁰, Stan B Kaye¹¹, Simon P G Padley³, Anand Devaraj¹²; West London Lung Screening Collaboration Group

Collaborators

West London Lung Screening Collaboration Group:
Fiona McDonald, Jan Lucas Robertus, Eric Lim, Joseph Barnett, Jonathan Finch, Paras Dalal, Nadia Yousaf, Armita Jamali, Natallia Ivashniova, Claudette Phillips, Thomas Newsom-Davies, Richard Lee, Pritti Vaghani, Sarah Whiteside, Stephen Vaughan-Smith

Affiliations

¹ Royal Brompton and Harefield NHS Foundation Trust, Department of Radiology, Sydney Street, London, SW3 6NP, UK.
² 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.
³ 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.
⁴ Royal Brompton and Harefield NHS Foundation Trust, Department of Respiratory Medicine, Harefield Hospital, Hill End Road, Harefield, UB9 6JH, UK.
⁵ 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.
⁶ 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.
⁷ Royal Brompton and Harefield NHS Foundation Trust, Department of Histopathology, Sydney Street, London, SW3 6NP, UK.
⁸ Royal Brompton and Harefield NHS Foundation Trust, Department of Thoracic Surgery, Sydney Street, London, SW3 6NP, UK.
⁹ RM Partners, The West London Cancer Alliance, 5th Floor, Alliance House, 12 Caxton Street, London, SW1H 0QS, UK.
¹⁰ Respiratory Biomedical Research Unit, Royal Brompton Hospital and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK.
¹¹ RM Partners, Sycamore House, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK.
¹² 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. Electronic address: A.Devaraj@rbht.nhs.uk.

PMID: 32771715
DOI: 10.1016/j.lungcan.2020.07.027

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 PLCO_M2012 6-yr risk ≥1.51 % and/or LLP_v2 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 LLP_v2 ≥2.0 % only, 71/1159 (6.1 %) had a PLCO_M2012 ≥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 PLCO_M2012 threshold of ≥1.51 %; all had a LLP_v2 ≥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 LLP_v2 model was more permissive; recruitment with PLCO_M2012 alone would have missed several cancers.

Keywords: Low dose CT; Lung cancer screening; Risk models; Risk prediction; Uptake.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Early Detection of Cancer*
Humans
London / epidemiology
Lung Neoplasms* / diagnosis
Lung Neoplasms* / epidemiology
Mass Screening
Pilot Projects
Risk Assessment
Tomography, X-Ray Computed