UK lung cancer trial shows screening at-risk groups lowers mortality rates
Results from the UK Lung Screening Trial (UKLS), the first lung cancer CT screening trial in the UK, have provided unequivocal support for lung cancer screening in identified high risk groups.
The findings presented at the 2021 IASLC World Lung Cancer Conference and published today in the Lancet Regional Health Europe will also be presented to the UK National Screening Committee.
The UKLS study of single LDCT (low dose computed tomography) indicates a reduction of lung cancer death of similar magnitude to major trials outside the UK, including the US National Lung Screening Trial (NLST) and the Dutch-Belgian NELSON trial.
Eligible groups aged 50-75 were assessed with the LLP risk score (for risk of developing lung cancer over five years). From October 2011 to February 2013, UKLS researchers randomly allocated 4,055 high risk participants to either a single invitation to screening with LDCT or to no screening (usual care).
Data were collected on lung cancer cases and deaths to 29 February 2020 through linkage to national registries. The primary outcome was mortality due to lung cancer. Researchers included the results in a random-effects meta-analysis to provide a synthesis of the latest randomised trial evidence.
1,987 participants in the intervention and 1,981 in the usual care arms were followed for approximately seven years. 86 cancers were diagnosed in the LDCT arm and 75 in the control arm. 30 lung cancer deaths were reported in the screening arm, and 46 in the control arm. The benefit in terms of lung cancer mortality was seen most strikingly in years 3 to 6 after randomisation.
The results from nine randomised controlled trials, including the UKLS, were included in the meta-analysis, which indicated a significant reduction in lung cancer mortality with a pooled overall relative rate of 0·84 from nine eligible trials (i.e. a 16% relative reduction in lung cancer).
This research was funded by the NIHR Health Technology Assessment programme, the NIHR Policy Research programme, and Roy Castle Lung Cancer Foundation.
Corresponding author Professor John Field, University of Liverpool said: “The UKLS trial provided the springboard for the Healthy Lung implementation projects, which followed its initial publication; starting with the Liverpool Health Lung Programme, followed by projects in Manchester, London, Yorkshire and most recently the large NHS England Targeted Lung Health Check. The UKLS mortality data and recent meta-analysis provides the impetus to now put in place a long-term lung cancer screening or lung health lung programme incorporating LDCT screening in the UK and also encourage nations in Europe to start their own programmes. Lung cancer early detection and surgical intervention saves lives.”
Professor Stephen Duffy, Queen Mary University and lead UKLS statistician said: "These results add to the international evidence that low dose CT screening reduces the risk of death from lung cancer. They also demonstrate that such screening can be made to work in the UK. Low dose CT can be added to the armoury of potential tools for the control of lung cancer."
Professor Anne Mackie, Director of Screening for Public Health England said: “The UK National Screening Committee welcomes this important research and has worked with the research team leading the trial to ensure that the data informs the Committee’s discussions on a national lung cancer screening programme.”
Professor Sanjay Popat, Consultant Medical Oncologist at The Royal Marsden NHS Foundation Trust, said: "The results of the UKLS trial have made an important contribution to international screening data and will be extremely important in developing a national lung cancer CT screening programme in the UK. The UK lung cancer community strongly supports lung cancer screening as an important way to save lives and catch cancer early."
Paula Chadwick, CEO of the Roy Castle Lung Cancer Foundation said: “The results from the UKLS trial are incredibly encouraging in our continued fight to get ahead of lung cancer, keeping up the pressure for the implementation a national lung cancer screening programme in the UK.
“The results of this latest study are very apt, coming at a time when lung cancer is still reeling from the impact of the Covid-19 pandemic. With lung cancer referral rates still below expected levels, we need to find a way to not only recover from the pandemic but bring lung cancer survival rates in line with other cancers. This study, along with many other similar trials, shows screening for lung cancer works and has the ability to save many lives. We need this intervention and we need it now.”
The research was led by the University of Liverpool and Queen Mary University. The recruitment for the UKLS trial was undertaken at the Liverpool Heart & Chest Hospital NHS Foundation Trust, Royal Papworth Hospital NHS foundation and the radiological oversight by Royal Brompton Hospital.
The full study Lung cancer mortality reduction by LDCT screening: UKLS randomised trial results and international meta-analysis is available in the Lancet Regional Health Europe here: https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(21)00156-3/fulltext