Dickson, Jennifer Lisa; (2021) The Implementation of Low Dose CT Screening for Lung Cancer: Identification, Invitation and Uptake. Doctoral thesis (Ph.D), UCL (University College London).

Text Jennifer Dickson FINAL PhD e-thesis.pdf Access restricted to UCL open access staff until 1 November 2024. Download (32MB)

Abstract

Lung cancer causes more deaths worldwide than any other cancer due to predominantly late-stage diagnosis when curative treatment is not possible, therefore, early diagnosis is key. Lung Cancer Screening (LCS) using Low Dose CT (LDCT) reduces lung cancer specific mortality, leading the UK National Screening Committee (NSC) to consider the implementation of systematic population based LCS. No agreed process exists for identifying and inviting people for LCS. These studies used prospective, observational data from the SUMMIT Study. Individuals were identified via primary care records and invited to a Lung Health Check (LHC), where, following telephone screening questions to confirm LHC eligibility, their LCS (via SUMMIT) eligibility was assessed and LDCT performed. The combined approach of using primary care records and telephone screening questions correctly identified people for LCS with acceptable levels of concordance between extracted data and self-reported responses. The broad invitation criteria were necessary to account for inconsistences in primary care records and to reduce eligible people being missed. Telephone screening questions estimating lung cancer risk were successful in identifying 42.8% of responders as being ineligible for the LHC, thus improving the efficiency of LHC clinic utilisation. Concordance of telephone screening and LHC responses was high, but disparities were observed across ethnic groups. Overall uptake of the LHC invitation was 31.0%, potentially increasing to 40.7% using a repeat round of invitation letters for non-responders. Response to reminder letters was greater than to invitation letters and increased with increasing deprivation and current smoking status. Uptake was reduced in men, increasing deprivation and current smokers. Asian ethnicity was associated with increased uptake and no ethnic group was independently associated with reduced uptake. These findings present a feasible, successful, and scalable approach to identifying and inviting individuals for LCS whilst optimising the efficient running of LHC clinic appointments and LDCT scanning capacity.

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