Proactively targeting people at higher risk of developing lung cancer is identifying the disease much earlier, with the potential of saving many lives, according to different studies being presented at the British Thoracic Society (BTS) Winter Meeting this week.
Researchers and evaluators from pilots across England will tell lung specialists at the conference that their targeted activity is also helping identify other lung diseases such as chronic obstructive pulmonary disease (COPD) - as well as other types of cancer. It is also providing a key opportunity to promote advice and support on keeping our lungs healthy over the long term – including treatment for tobacco dependence.
In each area, screening was undertaken with a group of people at higher risk of developing lung cancer – the exact criteria varied slightly between areas but in broad terms included current and ex-smokers aged between 55-75 years. Some areas included previous diagnosis of COPD.
The key outputs from each local initiative are as follows:
- In Liverpool: 1.9% of 1968 people screened with a low dose CT scan were found to have lung cancer (i.e. 39 people), of which 76% had been caught at an early stage. In addition, 10% of people who did not have an existing diagnosis of COPD and had a lung health check went on to be diagnosed with the condition.
- In Manchester: 4.4% of 1,384 people screened with a low dose CT scan across two screening rounds were found to have lung cancer (i.e. 61 people), of which 80% were treated at an early stage.
- In South Tyneside: 1.02% of 591 people screened with a low dose CT scan were found to have biopsy-proven lung cancer, all receiving treatment with curative intent. A further six people are currently undergoing further investigations for suspected lung cancer. In addition two people with breast cancer were also identified.
A summary of each initiative follows:
Evaluators in the Liverpool Lung Cancer Unit and partners launched the ‘Liverpool Healthy Lung Programme’ two years ago. 13,671 people aged between 58-75 years who were current or ex-smokers were invited by their GP to a ‘lung health check.’ This involved nurse support on quitting smoking, advice on diet and exercise and crucially a simple breath test (spirometry) to identify COPD. An assessment for lung cancer was also offered and if a risk was identified through a simple questionnaire, a low dose CT scan was offered.
Dr Martin Ledson, Consultant Respiratory Physician at the Liverpool Lung Cancer Unit, said:
“A key factor in our programme’s success was overcoming some of the fatalism that can exist around lung cancer which historically may have prevented some people in accepting an invitation to get tested.
All of our messages were positive and focused on the importance of getting a ‘Lung MOT’ to see what steps were needed to keep the lungs as healthy as possible in the future. We also stressed that the earlier lung problems are diagnosed the better the outcome.
As a result, virtually everyone who took part in the check felt positive about having done it, and would refer a friend if they felt they needed the check.”
In South Tyneside
Lung health experts in South Tyneside took a different approach - screening was introduced through existing NHS practice by targeting patients already scheduled for annual reviews for their COPD.
GP surgeries across the area screened their COPD patient lists for those at higher risk. The criteria included: those aged 55-74 with a COPD diagnosis (using spirometry), emphysema diagnosed on previous imaging, and smoking history of 10 or more pack years.
The practice nurse then offered eligible COPD patients a low dose CT scan and promoted the benefits of quitting smoking as appropriate.
Dr Liz Fuller, Respiratory Consultant and Lung Cancer Lead for South Tyneside Trust, explains:
“As a high proportion of lung cancer patients have COPD, we decided to look at a pilot with our existing COPD patients across our 22 GP practices, since they are already engaged in an annual review. This was a joint venture with South Tyneside CCG within our current financial constraints.
We kept it simple and pragmatic, targeting patients in a check that would happen anyway, rather than setting up a whole new appointment. We are getting real results in a low cost way.”
In Manchester, lung cancer screening was brought to public spaces such as supermarket car parks.
With funding from Macmillan and Manchester Clinical Commissioning Groups, lung specialists from Wythenshawe Hospital & Manchester University NHS Foundation Trust secured significant results by targeting ever-smokers, aged 55-74 years, in three separate areas of the city. They were offered a free ‘Lung Health Check’, with those identified of being at higher risk of developing lung cancer offered an immediate low dose CT screen on a mobile CT.
Dr Richard Booton, Consultant Respiratory Physician and Clinical Director for Thoracic Oncology at Manchester University NHS Trust, said:
“One of our key propositions was to make the service available to those at high risk and most likely to benefit from the Health Check. Siting screening vehicles in easily accessible areas such as supermarkets made the service convenient and enabled a high uptake within deprived areas.
The overall positive approach to our campaign led to over 2,500 people agreeing to a lung health check, and in those that had CT screening, we detected a high proportion of lung cancers at an early curable stage.”
Dr Lisa Davies, consultant lung specialist and Chair of the British Thoracic Society’s Board, said:
“Each of these initiatives has taken a slightly different approach, but what unites them is success in detecting early stage lung cancer, which can be treated more successfully. The results are creating a stronger sense of hope that lung cancer can be beaten if diagnosed early – which I hope will encourage more people in target groups to be tested.
In addition, these approaches are helping detect other lung diseases and will no doubt save many lives in the future. Crucially they are also providing an invaluable opportunity to talk to people about how to keep their lungs as healthy as possible through exercise, diet and stopping smoking.
The next step is to analyse what is working locally and globally – to create a national programme of activities that will diagnose lung cancer and chronic lung disease earlier. This will be key in combatting and reducing the devastating health and economic toll of lung disease.”
Over 43,000 people are diagnosed with lung cancer in the UK each year. It is the second most common form of cancer in the UK, after breast cancer, although it kills more people i.e. 35,500 people a year.
Chronic obstructive pulmonary disease (COPD)is the name for a group of lung diseases that narrow the airways causing breathing difficulties. In total, 1.2 million people in the UK have been diagnosed with COPD. There are 30,000 deaths from the disease in the UK each year.
For more information prior to the British Thoracic Society Winter Meeting (i.e. before Wednesday 5th December 2018):
Charlotte Sutton: t: 07958 279240
Alessandra McKenna t: 07967 976652
Ed Gyde t: 0780 9574801
During the British Thoracic Society meeting (from Wednesday 5th to Friday 7th December 2018):
Please contact the BTS news media office on t: 020 7798 4543 / 020 7798 4541 or the mobile numbers above.
Note to Editors:
The British Thoracic Society is the UK’s professional body of respiratory specialists. The Society seeks to improve standards of care for people who have respiratory diseases and to support and develop those who provide that care. A registered charity, it has about 3,500 members including doctors, nurses, respiratory physiotherapists, scientists and other professionals with a respiratory interest.
The British Thoracic Society Winter Meeting takes place between 5-7 December 2018 at the Queen Elizabeth II Conference Centre in Westminster, London.
 Evaluation by Liverpool Lung Cancer Unit, Aintree University Hospital, Liverpool, Liverpool CCG and University of Liverpool, QMUL