Dr Samuel Kemp
Consultant Respiratory Physician,
Nottingham City Hospital
Lung cancer screening is more important than ever, as more patients present with late stages of the disease as a result of COVID-19 delays.
“Around 75% of lung cancer cases are currently detected at an incurable stage,” explains Dr Samuel Kemp, Consultant Respiratory Physician at Nottingham City Hospital. According to Cancer Research UK, just 3% of patients diagnosed at stage four can expect to live for five or more years, which is why early detection is so vital.
Around 75% of lung cancer cases are currently detected at an incurable stage.
This issue is particularly acute right now. During the early throes of the pandemic, lung health checks were put on hold, staff were redeployed, CT scanners were prioritised for COVID-19 and many patients stayed away from all healthcare settings altogether. The result has been later diagnosis and poorer outcomes, which is why Kemp believes lung cancer screening is so important.
“COVID-19 has been catastrophic,” he explains. “We saw a 75% drop in referrals and are now seeing patients presenting with much later stages of the disease. It will be a while before we get statistics on survival rates, but it could wipe out 10 years of progress.”
CT screening saves lives
Low-dose CT screening has proved to be an extremely effective tool in identifying abnormalities on the lung that could be cancerous. Studies from the NELSON lung cancer trials conducted over a 10 year period showed lung cancer deaths in those who took part in screening fell by about 33% in women and 24% in men, compared to patients who did not undergo screening.
In 2019, the NHS embarked on a four-year pilot to conduct lung health checks, which included low-dose CT screening, for at-risk groups in 14 locations. Early results were promising. In Manchester, the NHS reported the percentage of cancers diagnosed at stage one increased from 18% to 68%, giving patients more options and better outcomes.
Statistics like this are hard to argue with, but as health professionals deal with the fallout from COVID-19 most trials remain on hold, but we can’t pause forever; lives are at risk.
Removing barriers reaps benefits of CT screening
Samiran Dey
European Business Development Manager, Fujifilm Medical Systems
Lung health checks have proven to be a huge success in removing barriers to healthcare and improving outcomes for patients.
Drawing on evidence from the national lung cancer screening trial in the US, and NELSON study, there have been initiative screening pilots run in the UK, such as the SUMMIT study in North London, that proved a pickup rate in early stage lung cancer detection, leading to curative treatment rather than palliative care.
Another initiative, the Manchester lung health check pilot, has seen the number of cancers diagnosed at stage one increase from 25% to 68%. Delivered everywhere from supermarket car parks to football stadiums, the programme has removed barriers which previously prevented people from coming forward.
A single one-stop community-based unit can screen as many as 60 patients a day, identifying those most at risk as early as possible.
Wider benefits
The improvement in early diagnosis is impressive, but the benefits of the lung health checks are far more wide reaching. The lung health check consultations address which patients require the low-dose CT scan but can also assist with smoking cessation for attendees; helping to reduce their chance of developing cancer and improving long term survival.
It is important to remember that lung cancer screening is more important than ever, as more patients present with late stages of the disease as a result of COVID-19 delays. Lung health checks have proven to be a huge success in removing barriers to healthcare and improving outcomes for patients. Lung cancer screening is needed to reverse COVID-19 damage.
Removing barriers to access
Removing barriers to reap the benefits of low-dose CT screening, early diagnosis is just the start. If it is not followed up swiftly with further tests and treatment, opportunities will be wasted and lives will be lost. One in five patients sees their cancer stage change while they are waiting for treatment. As the rollout of the programme is considered in a further 20 locations, connected working and a continued commitment to removing barriers are vital.
The uptake of lung health checks will require a greater need for the NHS to deliver the post-screening diagnostic confirmations leading to referrals of treatment options in order for the screening programmes to remain within, if not shorten, the lung cancer diagnostic pathway. This will require increased capacity and funding for infrastructure in order to develop a successful nationwide programme. The first step in battling lung cancer is to establish an effective screening programme.
