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UK Lung Cancer RCT Pilot Screening Trial: baseline findings from the screening arm provide evidence for the potential implementation of lung cancer screening

Field, J. K., Duffy, S. W., Baldwin, D. R., Whynes, D. K., Devaraj, A., Brain, Katherine Emma, Eisen, T., Gosney, J., Green, B. A., Holemans, J. A., Kavanagh, T., Kerr, K. M., Ledson, M., Lifford, Kate, McRonald, F. E., Nair, A., Page, R. D., Parmar, M. K. B., Rassl, D. M., Rintoul, R. C., Screaton, N. J., Wald, N. J., Weller, D., Williamson, P. R., Yadegarfar, G. and Hansell, D. M. 2016. UK Lung Cancer RCT Pilot Screening Trial: baseline findings from the screening arm provide evidence for the potential implementation of lung cancer screening. Thorax 71 (2) , pp. 161-170. 10.1136/thoraxjnl-2015-207140

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Abstract

Background: Lung cancer screening using low-dose CT (LDCT) was shown to reduce lung cancer mortality by 20% in the National Lung Screening Trial. Methods: The pilot UK Lung Cancer Screening (UKLS) is a randomised controlled trial of LDCT screening for lung cancer versus usual care. A population-based questionnaire was used to identify high-risk individuals. CT screen-detected nodules were managed by a pre-specified protocol. Cost effectiveness was modelled with reference to the National Lung Cancer Screening Trial mortality reduction. Results: 247 354 individuals aged 50–75 years were approached; 30.7% expressed an interest, 8729 (11.5%) were eligible and 4055 were randomised, 2028 into the CT arm (1994 underwent a CT). Forty-two participants (2.1%) had confirmed lung cancer, 34 (1.7%) at baseline and 8 (0.4%) at the 12-month scan. 28/42 (66.7%) had stage I disease, 36/42 (85.7%) had stage I or II disease. 35/42 (83.3%) had surgical resection. 536 subjects had nodules greater than 50 mm3 or 5 mm diameter and 41/536 were found to have lung cancer. One further cancer was detected by follow-up of nodules between 15 and 50 mm3 at 12 months. The baseline estimate for the incremental cost-effectiveness ratio of once-only CT screening, under the UKLS protocol, was £8466 per quality adjusted life year gained (CI £5542 to £12 569). Conclusions: The UKLS pilot trial demonstrated that it is possible to detect lung cancer at an early stage and deliver potentially curative treatment in over 80% of cases. Health economic analysis suggests that the intervention would be cost effective—this needs to be confirmed using data on observed lung cancer mortality reduction.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
Publisher: BMJ Publishing Group
ISSN: 0040-6376
Funders: NIHR
Date of First Compliant Deposit: 5 May 2016
Date of Acceptance: 3 November 2015
Last Modified: 12 Sep 2019 13:49
URI: http://orca.cf.ac.uk/id/eprint/90436

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