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, K.E.; Eisen, T.; Gosney, J.; Green, B.A.; Holemans, J.A.; Kavanagh, T.; Kerr, K.M.; Ledson, M.; Lifford, K.J.; 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.; Hansell, D.M.
Thorax 71(2): 161-170
ISSN/ISBN: 1468-3296 PMID: 26645413 DOI: 10.1136/thoraxjnl-2015-207140
Lung cancer screening using low-dose CT (LDCT) was shown to reduce lung cancer mortality by 20% in the National Lung Screening Trial. 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. 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 mm(3) 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 mm(3) 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). 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. ISRCTN 78513845.