Implementation of lung cancer screening: lessons from a local lung cancer screening pilot
File(s)
Author(s)
Bartlett, Emily
Type
Thesis
Abstract
Growing evidence from screening trials suggests that computed tomography (CT) screening for lung cancer reduces lung cancer mortality, but lung cancer screening has not yet been approved by the UK national screening committee.
This thesis sought to answer questions about how lung screening might be implemented outside a trial setting. Clinical questions included how to maximise participant uptake and attendance for screening, how risk models used in UK pilots to select participants for screening compare in identifying individuals at high risk of cancer, and the downstream consequences of the detection of incidental findings during screening for primary and secondary care. From a radiological angle, workforce requirements for population-based screening are unknown and questions surround the optimisation of nodule management protocols for screening, and how consistent, high-quality reporting can be achieved.
The West London pilot confirmed that with use of risk-based prediction models, lung cancer can be detected with a prevalence of >2.0%. Whilst screening has been advocated as a means to detect undiagnosed cardiovascular and respiratory disease, data from the West London pilot have demonstrated that despite a potential benefit of the identification of such disease, future work will be required to maximise actual benefits, with few participants referred to primary or secondary care having a subsequent change in management.
A study of radiologist reading times demonstrated that lung screening scans can ordinarily be reported in <5 minutes. Radiologist adherence to nodule management guidelines is, however, crucial. The development of a tabulated algorithm and subsequently a mobile phone application to assist radiologists demonstrated that greater adherence to protocols can be achieved than when following flow chart algorithms. A small interobserver agreement study involving clinicians involved in screening from other UK screening centres indicated the need for amendments to the current nodule management guidelines for several challenging nodule management scenarios.
This thesis sought to answer questions about how lung screening might be implemented outside a trial setting. Clinical questions included how to maximise participant uptake and attendance for screening, how risk models used in UK pilots to select participants for screening compare in identifying individuals at high risk of cancer, and the downstream consequences of the detection of incidental findings during screening for primary and secondary care. From a radiological angle, workforce requirements for population-based screening are unknown and questions surround the optimisation of nodule management protocols for screening, and how consistent, high-quality reporting can be achieved.
The West London pilot confirmed that with use of risk-based prediction models, lung cancer can be detected with a prevalence of >2.0%. Whilst screening has been advocated as a means to detect undiagnosed cardiovascular and respiratory disease, data from the West London pilot have demonstrated that despite a potential benefit of the identification of such disease, future work will be required to maximise actual benefits, with few participants referred to primary or secondary care having a subsequent change in management.
A study of radiologist reading times demonstrated that lung screening scans can ordinarily be reported in <5 minutes. Radiologist adherence to nodule management guidelines is, however, crucial. The development of a tabulated algorithm and subsequently a mobile phone application to assist radiologists demonstrated that greater adherence to protocols can be achieved than when following flow chart algorithms. A small interobserver agreement study involving clinicians involved in screening from other UK screening centres indicated the need for amendments to the current nodule management guidelines for several challenging nodule management scenarios.
Version
Open Access
Date Issued
2021-07
Date Awarded
2021-11
Copyright Statement
Creative Commons Attribution NonCommercial Licence
License URL
Advisor
Devaraj, Anand
Kemp, Samuel
Maher, Toby
Walsh, Simon
Publisher Department
National Heart & Lung Institute
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)