In a UK prospective longitudinal cohort study (SUMMIT) reported in The Lancet Oncology, Bhamani et al found that large-scale, low-dose computed tomography (CT) screening for lung cancer is effective and “can be delivered efficiently” in a diverse high-risk population.
As stated by the investigators: “Low-dose CT screening reduces lung cancer mortality. In advance of planned national lung cancer screening programs, research is needed to inform policies regarding implementation.”
Study Details
Individuals between the ages of 55 and 77 recorded as current smokers in primary care records at any point within the past 20 years were identified from 329 primary care practices in London and invited for a lung health check via postal letter. Individuals were considered at high risk and eligible for the study if they met the 2013 U.S. Preventive Services Taskforce criteria (current or former smokers within the past 15 years with at least 30 pack-year smoking histories) or had a Prostate, Lung, Colorectal, and Ovarian 2012 model 6-year risk of at least 1.3% and were not receiving treatment for an active cancer.
These individuals underwent lung cancer screening via noncontrast, thin-collimation, low-dose CT. The current analysis reported findings from the baseline round of screening.
Key Findings
A total of 12,773 participants were recruited and analyzed between April 2019 and May 2021. A total of 261 participants (2.0%) received a lung cancer diagnosis, including 163 (1.3%) with screen-detected lung cancer and 98 (0.8%) with delayed screen-detected lung cancer (eg, after a 3- or 6-month nodule follow-up CT). A total of 276 participants (2.2%) were diagnosed with any intrathoracic malignancy after a positive screen.
Among the 261 participants with prevalent screen-detected lung cancer, 207 (79.3%) were diagnosed with stage I or II disease. Surgical resection was the primary treatment in 201 cases (77.0%). Including cases in which multiple resections were performed in the same participant, 28 of 241 resections (11.6%) were benign. One patient died within 90 days of surgery.
At 12 months, the sensitivity of the screening protocol for lung cancer was 97.0% (95% confidence interval [CI] = 95.0%–99.1%). The specificity was 95.2% (95% CI = 94.8%–95.6%), with a false-positive rate of 4.8% (95% CI = 4.4%–5.2%).
The investigators concluded: “Large-scale lung cancer screening is effective and can be delivered efficiently to an ethnically and socioeconomically diverse population.”
Sam M. Janes, PhD, of the Lungs for Living Research Centre, UCL Respiratory, University College London, is the corresponding author of The Lancet Oncology article.
Disclosure: The study was funded by GRAIL. For full disclosures of the study authors, visit thelancet.com.
