Debbie Cavers, Ahsan R Akram, Elizabeth K Sage, John D Maclay, Gordon W Cowell, James Mitchell, Graeme Dickie, Christine Campbell, Kathryn A Robb, Frank Sullivan, Peter Murchie, Aileen Neilson, Robert J C Steele, Edwin J R van Beek, David Weller
Recruitment of people for lung cancer screening using the smoking history recorded in their primary care EMR is feasible. This approach identifies a high-risk population with a high burden of both malignant and non-malignant disease, and with substantial undiagnosed disease burden. However, uptake was modest and socially patterned, highlighting the need for equity-focused implementation strategies, including repeated invitations and targeted engagement. These findings are particularly relevant as Scotland considers implementation of a national lung cancer screening programme within a health system characterised by marked geographical and socioeconomic inequalities. Further research should evaluate long-term outcomes, cost-effectiveness and strategies to improve equitable participation.
OBJECTIVES: To assess the feasibility and acceptability of delivering risk-stratified low-dose CT (LDCT) lung cancer screening across diverse geographical and socioeconomic settings in Scotland and to characterise uptake, participant profile and screening outcomes.
DESIGN: Prospective, multicentre pilot feasibility study with descriptive analysis.
SETTING: Primary and secondary care interface across four regional Health Boards in Scotland, encompassing urban, rural, remote and socioeconomically deprived populations.
PARTICIPANTS: 2801 individuals aged 50-74 years, identified from primary care electronic medical records (EMRs), with a history of smoking were invited (current or within 15 years where available); 668 (23.8%) responded. Of 608 assessed for eligibility (50.8% female; median age 63 years), 503 (82.7%) met at least one predefined high-risk criterion.
INTERVENTIONS: Invitation to a lung health check, followed by telephone-based risk assessment using US Preventative Services Task Force, Liverpool Lung Pathway version 2 and the Prostate, Lung, Colorectal and Ovarian Screening Trial criteria. High-risk participants were offered a one-off LDCT scan at local centres.
PRIMARY AND SECONDARY OUTCOME MEASURES: Primary: feasibility indicators including uptake, risk eligibility and scan completion. Secondary: prevalence of lung cancer, pulmonary nodules and incidental findings (eg, coronary artery disease, emphysema).
RESULTS: Response rate was 23.8% (668/2801), varying from 17.8% to 38.1% across practices and lower in more deprived areas. Of 503 eligible participants, 436 (86.7%) underwent LDCT. Abnormal findings were present in 83.3% of scans. Lung nodules were detected in 25.7% (112/436), with 11.8% requiring follow-up. Lung cancer was diagnosed in 1.15% (5/436; 95%), alongside five additional malignancies. Coronary artery disease was identified in 56.4% (246/436) and emphysema in 33% (144/436). Non-responders were more likely to be current smokers (69.3% vs 49.8%).
CONCLUSIONS: Recruitment of people for lung cancer screening using the smoking history recorded in their primary care EMR is feasible. This approach identifies a high-risk population with a high burden of both malignant and non-malignant disease, and with substantial undiagnosed disease burden. However, uptake was modest and socially patterned, highlighting the need for equity-focused implementation strategies, including repeated invitations and targeted engagement. These findings are particularly relevant as Scotland considers implementation of a national lung cancer screening programme within a health system characterised by marked geographical and socioeconomic inequalities. Further research should evaluate long-term outcomes, cost-effectiveness and strategies to improve equitable participation.