Tisi, Sophie; (2021) Implementing Low Dose CT Screening For Lung Cancer: The Role of Chronic Obstructive Pulmonary Disease. Doctoral thesis (Ph.D), UCL (University College London).

Text Tisi_Thesis.pdf Access restricted to UCL open access staff until 1 October 2024. Download (15MB)

Abstract

Chronic Obstructive Pulmonary Disease (COPD) and lung cancer rank as the third and fifth leading causes of mortality worldwide (1). Reducing burden from these diseases is a fundamental priority for healthcare services. Lung cancer screening (LCS) with low-dose CT (LDCT) has been shown to reduce lung cancer mortality by 20-24% (2,3). The LCS population are high risk for COPD, a disease recognised to be significantly under-diagnosed. Despite mortality benefits, there is no national LCS programme in the UK, with uncertainty as to the net benefit in those with COPD and whether LCS can alleviate COPD-related morbidity and mortality (4). This thesis reports the set-up and delivery of the SUMMIT Study, a large-scale LCS implementation study, particularly examining aspects of LCS implementation in the COPD population. The first part of this thesis examined a targeted approach combining symptoms and spirometry to identify undiagnosed clinically-relevant COPD within an LCS setting. This demonstrated that a pragmatic, quality-assured approach to spirometry performance can achieve good quality spirometry for the intention of case-finding without leading to lengthy appointment times. High rates of undiagnosed COPD (19.7% population) were identified in those most at risk of COPD under-diagnosis and importantly this approach was shown to improve smoking cessation rates and quality of life at 12-months follow-up. The second part of this thesis focused on outcomes following LDCT in those with airflow obstruction. A high prevalence of incidental findings was identified in those with COPD suggesting potential benefit in leveraging LDCT to improve outcomes in COPD- associated co-morbidities. Airflow obstruction was demonstrated to be a strong independent risk factor for lung cancer on baseline LDCT, with high rates of early stage lung cancers and curative treatments demonstrated in this group, even amongst those with advanced COPD. Finally, this thesis reports the set-up of a large unique bioresource from blood samples of participants consented to the SUMMIT study allowing a significant resource for future research in a population enriched with smoking-related co-morbidities.

Download activity - last month

Export as CSVXMLJSON

Download activity - last 12 months

Export as JSONCSVXML

Downloads by country - last 12 months

Export as XMLCSVJSON

Archive Staff Only

View Item