Participation in community-based lung cancer screening: the Yorkshire Lung Screening Trial

Crosbie, Philip A.J.; Gabe, Rhian; Simmonds, Irene; Hancock, Neil; Alexandris, Panos; Kennedy, Martyn; Rogerson, Suzanne; Baldwin, David; Booton, Richard; Bradley, Claire; Darby, Mike; Eckert, Claire; Franks, Kevin N.; Lindop, Jason; Janes, Sam M.; Møller, Henrik; Murray, Rachael L.; Neal, Richard D.; Quaife, Samantha L.; Upperton, Sara; Shinkins, Bethany; Tharmanathan, Puvan; Callister, Matthew E. J.

Abstract

Background Screening with low-dose computed tomography (LDCT) reduces lung cancer mortality; however, the most effective strategy for optimising participation is unknown. Here we present data from the Yorkshire Lung Screening Trial, including response to invitation, screening eligibility and uptake of community-based LDCT screening. Methods Individuals aged 55–80 years, identified from primary care records as having ever smoked, were randomised prior to consent to invitation to telephone lung cancer risk assessment or usual care. The invitation strategy included general practitioner endorsement, pre-invitation and two reminder invitations. After telephone triage, those at higher risk were invited to a Lung Health Check (LHC) with immediate access to a mobile CT scanner. Results Of 44 943 individuals invited, 50.8% (n=22 815) responded and underwent telephone-based risk assessment (16.7% and 7.3% following first and second reminders, respectively). A lower response rate was associated with current smoking status (adjusted OR 0.44, 95% CI 0.42–0.46) and socioeconomic deprivation (adjusted OR 0.58, 95% CI 0.54–0.62 for the most versus the least deprived quintile). Of those responding, 34.4% (n=7853) were potentially eligible for screening and offered a LHC, of whom 86.8% (n=6819) attended. Lower uptake was associated with current smoking status (adjusted OR 0.73, 95% CI 0.62–0.87) and socioeconomic deprivation (adjusted OR 0.78, 95% CI 0.62–0.98). In total, 6650 individuals had a baseline LDCT scan, representing 99.7% of eligible LHC attendees. Conclusions Telephone risk assessment followed by a community-based LHC is an effective strategy for lung cancer screening implementation. However, lower participation associated with current smoking status and socioeconomic deprivation underlines the importance of research to ensure equitable access to screening.

• Journal Article Type: Article
• Acceptance Date: May 17, 2022
• Online Publication Date: Jul 1, 2022
• Publication Date: Nov 1, 2022
• Deposit Date: May 30, 2022
• Publicly Available Date: Jul 2, 2023
• Journal: European Respiratory Journal
• Print ISSN: 0903-1936
• Electronic ISSN: 1399-3003
• Publisher: European Respiratory Society (ERS)
• Peer Reviewed: Peer Reviewed
• Volume: 60
• Issue: 5
• DOI: https://doi.org/10.1183/13993003.00483-2022
• Keywords: Pulmonary and Respiratory Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/8305480
• Publisher URL: https://erj.ersjournals.com/content/60/5/2200483
• Additional Information: This is an author-submitted, peer-reviewed version of a manuscript that has been accepted for publication in the European Respiratory Journal, prior to copy-editing, formatting and typesetting. The publisher is not responsible or liable for any errors or omissions in this version of the manuscript or in any version derived from it by any other parties. The final, copy-edited, published article, which is the version of record, is available without a subscription 18 months after the date of issue publication.