UK Lung Cancer RCT Pilot Screening Trial: baseline findings from the screening arm provide evidence for the potential implementation of lung cancer screening

BackgroundLung cancer screening using low-dose CT(LDCT) was shown to reduce lung cancer mortality by20% in the National Lung Screening Trial.MethodsThe pilot UK Lung Cancer Screening (UKLS)is a randomised controlled trial of LDCT screening forlung cancer versus usual care. A population-basedquestionnaire was used to identify high-risk individuals.CT screen-detected nodules were managed by a pre-specified protocol. Cost effectiveness was modelled withreference to the National Lung Cancer Screening Trialmortality reduction.Results247 354 individuals aged 50–75 years wereapproached; 30.7% expressed an interest, 8729(11.5%) were eligible and 4055 were randomised, 2028into the CT arm (1994 underwent a CT). Forty-twoparticipants (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%) hadstage I or II disease. 35/42 (83.3%) had surgicalresection. 536 subjects had nodules greater than50 mm3or 5 mm diameter and 41/536 were found tohave lung cancer. One further cancer was detected byfollow-up of nodules between 15 and 50 mm3at12 months. The baseline estimate for the incrementalcost-effectiveness ratio of once-only CT screening, underthe UKLS protocol, was £8466 per quality adjusted lifeyear gained (CI £5542 to £12 569).ConclusionsThe UKLS pilot trial demonstrated that itis possible to detect lung cancer at an early stage anddeliver potentially curative treatment in over 80% ofcases. Health economic analysis suggests that theintervention would be cost effective—this needs to beconfirmed using data on observed lung cancer mortalityreduction