Further positive data published for lung cancer screening
The early detection of lung cancer is an exciting field with the potential to greatly improve patient survival. The topic of screening dominates the agenda in this area.
Highly anticipated data from the Dutch-Belgian lung cancer screening trial, NELSON, has been published in the New England Journal of Medicine. This adds weight to the clear and mounting clinical evidence in favour of low-dose computed tomography (LDCT) screening for individuals at high-risk of developing lung cancer. In NELSON, lung cancer mortality was significantly reduced in high-risk individuals who underwent LDCT.1
Following the reporting from the US National Lung Screening Trial (NLST) in 2011, the US Preventive Services Task Force (USPSTF) recommended annual LDCT screening for lung cancer in December 2013.2,3 Pilot programmes of LDCT lung cancer screening have been running in the UK and guidelines have been developed, but the nationwide implementation of screening has not yet happened. It is hoped that following the release of the European screening data from NELSON, that a UK-wide lung cancer screening programme can begin. Following the randomized controlled UK Lung Cancer Screening pilot trial (UKLS), and multiple real world and pilot studies, such as the Lung Screen Uptake Trial (LSUT) and the Manchester Lung Health Check Pilot, it is safe to say that the UK is prepared for implementation.4-6
Around the world, screening programmes and trials are in various stages of development. For example, the Korean Lung Cancer Screening Project (K-LUCAS) led to the introduction of the Korean National Cancer Screening Program (KNCSP) in July 2019.7,8 While in Europe, the baseline results of the French screening trial DEP KP80 were published in October 2019.9
One consideration for lung cancer screening is that nodules, which may or may not be malignant, can be detected, leading to unnecessary biopsies and stress for patients who do not have lung cancer. Methods of determining which nodules require further testing are being developed to address this. There is also a need to consider smoking cessation programmes within screening. For the future of lung cancer screening globally, a challenge will be to overcome the hurdle of screening access, since some countries may not possess the resources to provide the service.
Nevertheless, the future for lung cancer screening is exciting and the recent news from NELSON will be widely welcomed by the UK lung cancer community.
For video interviews on lung cancer screening, including the trials mentioned above, please click here. For our coverage of the 2020 British Thoracic Oncology Group (BTOG) Annual Conference please click here.
Written by Cally Cameron Smith
- de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial. N Engl J Med. 2020 Jan 29. [Epub ahead of print]
- National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011 Aug 4;365(5):395-409.
- USPreventiveServicesTaskForce.org [Internet]. U.S. Preventive Services Task Force. Lung cancer: screening. Recommendation summary. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening. Published 2013. [Accessed 31 Jan 2020].
- Field JK, Duffy SW, Baldwin DR, et al. UK Lung Cancer RCT Pilot Screening Trial: baseline findings from the screening arm provide evidence for the potential implementation of lung cancer screening. Thorax. 2016 Feb;71(2):161-70.
- UCL.ac.uk [Internet]. United Kingdom. The Lung Screen Uptake Trial (LSUT). Available from: https://www.ucl.ac.uk/epidemiology-health-care/research/bsh/research/cancer-communication-screening/lung-screen-uptake-trial-lsut. [Accessed 31 Jan 2020].
- Crosbie PA, Balata H, Evison M, et al. Second round results from the Manchester ‘Lung Health Check’ community-based targeted lung cancer screening pilot. Thorax. 2019 Jul;74(7):700-704.
- Lee J, Lim J, Kim Y, et al. Development of Protocol for Korean Lung Cancer Screening Project (K-LUCAS) to Evaluate Effectiveness and Feasibility to Implement National Cancer Screening Program. Cancer Res Treat. 2019 Oct;51(4):1285-1294.
- LungCancerNews.org [Internet]. USA. Korean Lung Cancer Screening Project (K-LUCAS) Led to Launch of New National Lung Cancer Screening Program in Korea. Available from: https://www.lungcancernews.org/2019/08/14/3165/. [Accessed 31 Jan 2020].
- Leleu O, Basille D, Auquier M, et al. Lung Cancer Screening by Low-Dose CT Scan: Baseline Results of a French Prospective Study. Clin Lung Cancer. 2019 Oct 31. [Epub ahead of print]