UK Lung Cancer Screening Program

The UK Lung Cancer Screening Trial (UKLS) was the first lung cancer screen trial to take place in the UK and hopes to benefit people who are at risk of developing lung cancer. Lung cancer affects the lives of about 40,000 people a year in the UK, by screening for the disease UKLS hopes that earlier diagnosis may result in more successful treatment for those patients.

It is important to point out that anybody can develop lung cancer at anytime, however there are a number of factors that increase the likelihood of contracting the disease for example exposure to tobacco smoke or asbestos.

The UKLS trial was carried out in conjunction with The Liverpool Heart & Chest Hospital (NHS Liverpool, Knowsley & Sefton) and Papworth Hospital (NHS Cambridgeshire, Bedfordshire & Peterborough) to identify potentially at risk patients within their catchment areas. In total UKLS wrote to over 250,000 men and women between the ages of 50-75 to ask them to participate in completing a questionnaire. The results of the completed questionnaires were used to risk model the potential likelihood of an individual contracting lung cancer and individuals deemed to be high risk were asked to complete a second questionnaire to confirm their potential risk and eligibility to attend a screening clinic.

During the screening clinics various data and information were collected including a low dose CT scan of the lungs taken which was reviewed by a radiologist. Any signs of lung cancer initiated a prompt referral to the local hospital and to specialists who carried out further investigations and any necessary treatments. Those with smaller abnormalities (nodules) that had the potential to be early lung cancers were also followed up with repeat low dose CT scans.

UKLS was funded by The National Institute for Health Research, Health Technology Assessment programme (Reference number HTA 09/61/01) and the results  published in the Health Technology Assessment journal series [Field, JK et al.  (2016). Health Technology Assessment, 20 (40). 1 – 14610.3310/hta20400] and in Thorax [Field et al., Thorax 2016;71:161–70.doi:10.1136/thoraxjnl-2015-207140].

Following long-term follow-up, the UKLS risk questionnaire data was used to validate the LLPv2 risk score and provide a new version (LLPv3) with more accurate absolute risk prediction [Field et al., Thorax 2021, 76(2):161-168. DOI: 10.1136/thoraxjnl-2020-215158].

We have now identified a lung cancer mortality reduction by low-dose CT screening in the UKLS lung cancer screening study that is of a similar magnitude as that seen for larger US and European studies (Field et al., Lancet Regional Health Europe, published online 11 Sep 2021, doi.org/10.1016/j.lanepe.2021.100179) and utilised the UKLS data in a meta-analysis of CT screening trials, demonstrating significant long-term gains in lung cancer mortality reduction. Furthermore, the lung cancer-related mortality was significantly better in the low-dose CT arm of UKLS than in the control arm. This was achieved in part by our ability to identify those at greatest risk of lung cancer, using the LLP lung cancer risk score, with UKLS being the first randomised control trial to take this risk-based approach to recruitment.