Today, the UK National Screening Committee has recommended introducing a targeted lung cancer screening programme across the UK, for those at high risk of the disease. This has the potential to greatly improve early diagnosis of lung cancer.
Screening programmes for breast, cervical and bowel cancer save thousands of lives from cancer each year. Now, the latest recommendation for screening provides hope to improve survival of one of the most common and hard-to-treat cancers.
With almost 35,000 lives lost to lung cancer every year, it’s the most common cause of cancer death in the UK. Improving outcomes in lung cancer remains one of our biggest challenges and survival from lung cancer remains low. One reason for this is that people are often diagnosed at a late stage, where there are fewer treatment options available.
This is where screening could step in.
Cancer screening programmes help reduce deaths from cancers by diagnosing them early or preventing them from developing in the first place. The decision on whether to recommend lung screening falls to the UK National Screening Committee (UK NSC), an independent body of experts that review evidence and advise on screening programmes.
So what would a targeted lung cancer screening programme look like, and what could it mean for lung cancer outcomes?
What is targeted lung cancer screening
The UK NSC recommends inviting people aged 55-74 who either smoke, or used to smoke, to an initial assessment. This is because smoking is the leading cause of lung cancer and is responsible for more than 7 in 10 cases in the UK. This is different to the current cancer screening programmes in the UK, which invite people based on just their age or gender.
The initial assessment will involve a health professional asking some questions to determine if someone is at a high risk of lung cancer. If they are, they will then be offered a low dose CT scan of the lungs.
A low dose CT scan helps to check for changes in the lungs that may be lung cancer. The scan uses x-rays and a computer to create detailed pictures of the lungs from different angles to form a 3D image.
A type of specialist doctor called a radiologist examines the scan and if it shows anything abnormal, the person may be invited for further tests. If somebody has suspected lung cancer, they will be referred so it can be diagnosed as soon as possible. If other abnormalities are found, they may be invited to screening more regularly. By screening people at high risk, we can find lung cancers earlier and save more lives from the disease.
Why is lung cancer screening not recommended for everyone?
We know that current cancer screening tests offered on the NHS save thousands of lives each year. But screening isn’t perfect and has harms as well as benefits.
All screening programmes must target groups of people where the benefits outweigh the harms. This is why current cancer screening programmes are only offered to certain age groups. Targeted lung screening will take this further, by inviting only those who are at a higher risk of developing cancer based on other factors – in this case smoking status.
Studies show that lung cancer screening reduces lung cancer deaths in people with a history of smoking. However, people who have never smoked are at a much smaller risk of lung cancer, so it’s unlikely that they would benefit from screening in the same way.
There are also harms associated with lung screening. These include exposure to small amounts of radiation from the test itself, false positives (where a potential cancer is incorrectly found and leads to unnecessary follow-up procedures) and false negatives (where the test misses a cancer).
Some people may also be diagnosed with a cancer that would never have gone on to cause harm in their lifetime. In other words, if the person hadn’t been tested, they might never have known they had cancer. This is known as overdiagnosis.
So targeting lung screening at people who smoke, or used to smoke, can maximise the balance of the benefits and harms of screening
From pilot scheme to national programme
In parts of England, some people are currently being offered a lung health assessment, followed by a low dose CT scan as part of a pilot scheme that has been running since 2019. These Targeted Lung Health Checks (TLHCs) could provide a model for how the national lung screening programme is implemented.
Developing screening programmes takes time, so it’s likely going to be a while before this programme is rolled out to the public. In England, these pilot sites are underway, but in Wales, Scotland and Northern Ireland, lung cancer screening has never been offered before, so may take time to set up.
It’s important that insights from trial sites in England are shared across the UK, so lung screening can be implemented as quickly as possible.
Currently, health services already have limited capacity to deliver enough diagnostic tests, checks and scans. Our calculations from September 2021 revealed that almost 55,000 cancer patients over six years in England should have been diagnosed quicker or started their treatment sooner. So, it’s vital that shortages in diagnostic staff are addressed to successfully roll out the programme.
Governments must take upcoming opportunities to tackle these issues and make sure early diagnosis is achievable for everyone. For example, in announcing the 10-year cancer plan for England the UK Government set out bold ambitions to address the problems facing early diagnosis and drive forward progress. But this must be matched with the investment and accountability from the government to meet that ambition. Similarly, the Scottish cancer strategy provides an opportunity to ensure Scotland’s cancer services are fit for the future.
A win for tackling health inequalities?
We need to address unacceptable and unjust cancer inequalities across the UK.
Lung cancer is more common in more deprived groups. This is largely due to higher rates of smoking in these groups.
There are around 30,000 extra cancer cases each year in the UK due to deprivation and lung cancer is the biggest contributor to these excess cases.
Other groups of people at a higher risk of tobacco related harm include those who identify as LGBTQ+, people with mental health conditions and those who are homeless. So, it’s clear that if we’re serious about tackling health inequalities in cancer outcomes, lung cancer is an area where we need to make significant advances. You can read more about why some groups of people are more likely to smoke in our inequalities series.
It’s vital to ensure that introducing a national lung cancer screening programme wouldn’t widen inequalities in lung cancer outcomes. For example, people from more deprived groups might be less likely to take up lung screening, as this is the case for existing screening programmes. And research shows that some people who smoke might face barriers to attending, such as believing that screening would not be able to help them. It’s important to accurately monitor who takes up lung cancer screening so its impact on inequalities can be measured.
All those invited to lung screening who want to attend should be able to do so. Further research is needed to understand the best ways to increase uptake in groups that have low attendance, but processes such as sending reminders to people who don’t respond, and targeting campaigns to promote uptake in specific groups, could be effective.
And finally, screening services must be accessible to groups of people who are more likely to smoke. These include people from more deprived areas, the LGBTQ+ community, people with mental health conditions and those experiencing homelessness. This is important, as we know people in some of these groups are less likely to engage with the healthcare system.
Prevention remains key in tackling lung cancer
The link between smoking and cancer is very clear. Smoking is responsible for over 70% of lung cancers and increases the risk of at least 14 other types of cancer.
It’s essential that stop smoking support is central to targeted lung cancer screening. This includes training screening staff to effectively deliver stop smoking interventions and ensuring that people receive continued support once they have completed screening.
Local, free stop smoking services which provide medication and behavioural support give people the best chance of stopping smoking. But these services are not available in all areas of the UK, putting some people at a disadvantage of successfully stopping smoking.
The governments across the UK must ensure that free local stop smoking services are available to everyone who wants to stop smoking, and that these services have enough staff members and funding.
There’s a lot that still needs to be done if we are to meet smokefree ambitions across the UK and we’ve previously written about what measures are needed in England. As well as ensuring stop smoking services are available to all, we’re asking the UK Government to introduce a ‘polluter pays’ type fund to make the tobacco industry pay for the damages smoking causes to public health, without being able to influence how the funds are spent. We’re previously written about what measures are needed in England.
Pilot schemes and trials have shown that people are positive about receiving stop smoking advice during screening. For example, in the Hull pilot, a large proportion of people referred from the programme engaged with stop smoking services. In the Yorkshire lung screening trial, at least 1 in 10 people successfully quit after 4 weeks of receiving support. We hope to see this extended across the UK with smoking cessation being a crucial element of the national lung cancer screening programme.
Although cancer screening is an important tool for early diagnosis, lung cancer screening alone won’t improve outcomes. Much more needs to be done across the UK. Healthcare professionals must be supported in recognising and referring people with signs and symptoms, and while treatments for lung cancer are improving, there’s more progress to be made, including making sure that everyone has equal access to high-quality treatment.
Screening is for people without symptoms. If you spot anything that’s unusual for you, or you’re worried that you are experiencing symptoms of lung cancer, speak to your doctor.
Stopping smoking is the best thing you can do to reduce your risk of lung cancer and improve your overall health. Find out more about how to get help. Remember it’s never too late to stop smoking and reduce your lung cancer risk.
Alice Davies and Sophie Brooks work in the Health Information team at Cancer Research UK