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Haval Balata
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MA05 - Lung Cancer Screening (ID 174)
- Event: WCLC 2020
- Type: Mini Oral
- Track: Screening and Early Detection
- Presentations: 2
- Moderators:
- Coordinates: 1/30/2021, 11:45 - 12:45, Scientific Program Auditorium
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MA05.04 - Why are Lung Cancer Detection Rates Higher in the Manchester Lung Health Checks than in the National Lung Screening Trial? (ID 2208)
11:45 - 12:45 | Author(s): Haval Balata
- Abstract
- Presentation
Introduction
Over two annual screening rounds, the lung cancer detection rate in the Manchester Lung Health Checks pilot was 4.5%, compared to 1.7% for the US National Lung Screening Trial (NLST). It is unknown whether this is explained by (1) the use of risk-based eligibility in Manchester (PLCOm2012≥1.51%); (2) possible differences in the distribution of risk between the trials; and/or (3) unexpectedly high lung cancer detection in certain groups.
Methods
We calculated lung cancer detection-rate ratios (DRRs) to quantify the impact of these influences after (1) applying Manchester’s eligibility criterion to the NLST; (2) additionally imposing equal distributions of risk by indirect standardization; and (3) additionally stratifying by descriptive variables including socioeconomic status and smoking history.
Results
The distribution of baseline lung cancer risk was higher in Manchester than in NLST, even after applying Manchester’s risk-based eligibility criteria to NLST (Figure). The crude DRR showed 2.6-fold higher lung cancer detection in Manchester compared with NLST (4.5% vs. 1.7%). The DRR was reduced to 2.1 after applying risk-based eligibility to NLST, and further to 1.7 after imposing equal risk distributions. The standardized DRR varied strongly with educational level (DRR=1.8, 1.6, and 1.2 in the lowest, middle, and highest categories) and with smoking intensity (DRR=2.9, 2.4, 1.7, and 1.3 for <10, 10-15, 16-30, and >30 cigarettes per day). It also increased with age.
Conclusion
Multiple influences led to higher lung cancer detection rates in Manchester compared with NLST, including risk-based eligibility and a higher average population risk. After accounting for these influences, detection remained markedly higher in Manchester than in NLST for certain groups, including those with lower smoking intensity and lower education.
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MA05.06 - Lung Cancer Screening – Cumulative Results from Five UK-Based Programmes (ID 3527)
11:45 - 12:45 | Presenting Author(s): Haval Balata
- Abstract
- Presentation
Introduction
Lung cancer remains the leading cause of cancer related death globally. Low-dose CT (LDCT) screening of high-risk individuals reduces lung cancer specific mortality. An important requirement for any screening programme is to minimise harms, especially in those who do not have cancer. Data from randomised controlled trials (RCT) is often used as the primary source from which to extrapolate risks of harm but they do not reflect modern, real-world practice. In this paper we present cumulative data on screening harms from five UK-based lung cancer screening programmes.
Methods
In the United Kingdom (UK), several implementation pilots and research studies have demonstrated that screening can be successfully delivered within or aligned to the NHS. These include: UK Lung Cancer Screening Trial (UKLS), Lung Screen Uptake Trial, Manchester Lung Health Checks, Liverpool Healthy Lung Project and Nottingham Lung Health MOT. Most sites, other than UKLS, used the British Thoracic Society (BTS) nodule management guidelines. Positive screening results were defined as those referred for more than a repeat LDCT. False positives were those positive screens without an eventual diagnosis of lung cancer. Harms were categorised according to the need for further imaging, invasive investigations and/or surgery. Complications were categorised as per the National Lung Screening Trial (NLST).
Results
A total of 11,815 screening LDCTs were performed across the five projects between 2016 and 2020. Overall, 85.5% of screening scans were categorised as negative, 10.5% as indeterminate and 4% as positive. Lung cancer detection was 2.1%, ranging from 1.7% to 4.4% across sites. The surgical resection rate was 66.0%. Details of the cumulative reported harms are summarised in Table 1.
Table 1. Details of cumulative reported harms
Reported screening related harm
Total % (n)
Per 1000 screening scans
False positive rate
As a proportion of all LDCT scans
1.9% (219)
17
As a proportion of all positive scans
(i.e. false discovery rate)
46.7% (219)
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Invasive investigation* for benign disease (excluding surgery)
0.5% (61)
5
Surgical resection for benign disease
As a proportion of all surgeries
4.6% (8)
1
As a proportion of all LDCT scans
0.07% (8)
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Major complication+ from invasive
investigation/treatment for benign disease
0% (0)
0
Deaths from invasive investigation/treatment for benign disease
0% (0)
0
*image guide biopsies or bronchoscopic procedures; +as defined by NLST
Conclusion
Discussion: This collaborative work provides up-to-date data on lung cancer screening performance and harms. The rate of positive (4%) and false positive (1.9%) screening results were significantly lower than NLST and the majority of European screening trials other than NELSON. Harms from investigation and treatment of non-malignant disease was minimised with no reported major complications or deaths. This provides reassurance that with the use of evidence-based practice and experienced lung MDTs, harms from false positive results can be minimised within screening. This information is important in the planning of larger scale implementation of lung cancer screening within the UK and beyond.
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