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%