Lung cancer screening: Manchester’s Lung Health Checks
Dr Phil Crosbie Senior Lecturer, University of Manchester
Honorary Consultant in Respiratory Medicine Early Detection Lead, Cancer Research UK Lung Cancer Centre of Excellence
Greater Manchester Cancer Conference November 2019
Lung cancer incidence: not evenly distributed
Cancer Research UK
European age standardised incidence rates by deprivation quintile, England (2006-10)
Public Health England
6/26/2016 Local Cancer Statistics : Cancer Research UK
http://www.cancerresearchuk.org/cancer-info/cancerstats/local-cancer-statistics/?location-name-1=NHS%20North%20Manchester%20CCG&location-1=01M 1/2
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Data is displayed at the geographic level at which it is published.
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NHS North Manchester CCG
Lung Incidence Rate
R egio n s (H o ver fo r details )
6 0
80
100
12 0
140
16 0
180
Incidence per 100,000 (including 95%
confidence intervals)
NHS North Manchester CCG National Average
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NorthManchesterCCG
SouthManchesterCCG
England and Wales
Region
Inci
den
ce p
er 1
00
,00
0 (
95
% C
I)
National average
Incidence rates by region, England and Wales
Tonge J et al Health Expectation 2019
Lung cancer paradox
Practical barriers most commonly cited • Balata et al Thorax 2019 • Ali et al BMJ Open 2015
Screening
n = 1,384
Mobile truck in supermarket car parks
Immediate access to
low dose CT scan
Lung
Cancer Risk
Lung Health
Check
n = 2,541
Smoking
advice
Spirometry
Symptoms
Booked Appointments
(n=2,827)
Demand very high High Low
Inclusion criteria: age 55-74 ever smokers14 participating GP practices
Exclusion criteria: CT thorax within 12 monthsterminally ill, lung cancer diagnosed within 5 yr
90% PS 0-135% current smokers
Annual LDCT screening over 2 screening rounds
56%
n = 1,384
*
Lung Health Check / lung MOT – age 55-74, ever smoker
Located in deprived areas– North, Central and South Manchester
Community-based– Supermarket car parks / free parking
Targeted at those most at risk– 6-yr lung cancer risk score ≥1.51% (PLCOM2012)
Immediate access to low dose CT (mobile)– One stop shop model for maximum convenience
0
200
400
600
800
1000
1200
1400
1600
1 2 3 4 5 6 7 8 9 10
Num
ber
of L
HC
atte
ndee
s
IMD decile Least deprivedMost deprived
IMD = Index of Multiple Deprivation (England 2015)
0
10
20
30
40
50
60
70
1 2 3 4
Pe
rce
nta
ge
(%
)
Lung cancer stage
GM Screening Screen detected LC: A). 80% early stage (<30% in GM) B). >90% offered curative intent treatment C). Surgical resection rate 4x national average
Lung cancer stage
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
NLST NELSON Manchester
Per
cen
tage
dia
gno
sed
wit
h lu
ng
can
cer(
%)
Study
Baseline Second round
Lung cancer detection rate
1 cancer detected for every 23 people screened
75% attendees in lowest deprivation quintile
Cardiovascular disease
Lung Cancer
COPD / Emphysema
Deprivation Smoking Age
Stopping smoking is the most important intervention
Preventing cardiovascular disease
Reducing smoking
Early detection of COPD
1 in 5 attendees no history of COPD but have airflow
obstruction
1 in 10 smokers stopped smoking. No sign licence
to smoke
1 in 3 attendees at high risk but not receiving primary prevention
Lung Health Check: results
Early stage Late stage
£4.2M funding to expand LHCs across North and East Manchester
Yorkshire Lung Screening Trial Chief Investigator: Dr Mat Callister (Leeds)
Co-chief Investigator: Dr Phil Crosbie (Manchester)
Funded by Yorkshire Cancer Research £5.9M Recruitment started Nov 2018 Telephone triage
Primary aims 1. Screening participation rates 2. Comparison screening selection criteria:
NLST (to age 80), PLCO (≥1.51%), LLP (≥5%) 3. Assess lung cancer outcomes in screening
vs. usual care
National Health Service for England
£70M investment to fund Lung Health Check pilots across England based on the Manchester model • Biennial screening over 2 rounds • Scale ≈ 60,000 individuals screened Protocol to standardise approach across sites Screening eligibility based on risk • PLCOM2012 - threshold ≥1.51% • LLPv2 – threshold ≥2.5%