Ruparel, Mamta; (2018) Implementing LDCT lung cancer screening in the UK: finding an evidence base for practical strategies. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Lung Cancer accounts for the greatest number of cancer deaths globally, with poor five-year survival rates of less than 13% in the UK. This is largely due to late stage of diagnosis. Lung cancer screening (LCS) has been shown to significantly reduce lung cancer-specific mortality but various questions on how best to implement LCS in the UK remain. This thesis examines various aspects related to the implementation of LCS and aims to inform on policy as well as future academic work. Part A used qualitative research methods to determine the information needs of LCS participants, and used this data to develop an information film which was shown to enhance knowledge and reduce decisional conflict without adversely affecting completion rates of low dose computed tomography (LDCT) examination in a randomised study. Part B used prospective observational data in an LCS demonstration pilot, the Lung Screen Uptake Trial, to evaluate the cancer and non-cancer findings. We determined that 98% of participants had high risk of cardiovascular disease (CVD), suggesting that detecting coronary calcium on LDCT may not add much value as almost all participants qualify for primary prevention strategies by virtue of clinical and demographic risk factors alone. We also discovered a significant burden of ‘undiagnosed’ airflow obstruction and that individuals with LDCT-detected emphysema and airflow limitation commonly have symptoms consistent with Chronic Obstructive Pulmonary Disease (COPD). Longitudinal studies are needed to determine whether this can impact COPD-related outcomes and whether communicating smoking-related incidental findings detected at LCS can impact smoking cessation. Finally, we demonstrated the feasibility of LCS in the UK, and report a higher ratio of cancers to indeterminate nodules than expected from clinical trials in LCS, while maintaining a predominance of early stage disease treated with curative intent. Through this, key areas are identified within policy, resource allocation and infrastructure, targeting of which would help ensure delivery of a high quality LCS service.

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