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Upon reading this news item, some readers may have concluded that low-dose computed tomography (LDCT) is now the accepted norm for lung cancer screening for high risk group.
However I have difficulty confirming this is the case, particularly when the UK Lung Cancer Screening Trial (UKLS) have yet to verify the cost effectiveness of this screening mode taking into account the magnitude of mortality reduction, rather than early detection of lung cancer alone.
Despite much touted plans to pool UKLS data with " NELSON (Nederlands Leuvens Longkanker Screenings Onderzoek: Dutch-Belgian Randomised Lung Cancer Screening Trial) and other European Union trials" (by 2017 - Ref 1) for optimal balance of disease mortality versus cost effectiveness, I have difficulty finding out if this has occurred; certainly conclusion of these analyses are yet unavailable to the wider public.
As such I am concerned that NHS England may have invested in a LDCT lung screening program whose cost effectiveness is yet to be proven; a perplexing situation at the time of NHS austerity, health budget uncertainty and cost cutting of public health services.
Professor Richard Sullivan is correct to flag the obsession of using expensive "new" technology in screening for cancer when "there are many other factors to consider", the issue of overdiagnosis and associated investigation/ intervention mortality and morbidity is not insignificant when dealing with large population numbers.
1) It isn't clear from the report whether this local pilot has been reviewed by the UK National Screening Committee. Simon Stevens states that he will be guided by the NSC. One would assume that a pilot will not be expanded to other regions without NSC support. It would be helpful to have clarity on this.
2) The specialist stop smoking service in the City of Manchester no longer exists, with support only available from GP practices and pharmacies. One wonders at the relative cost-effectiveness of specialist stop smoking services in preventing lung cancer versus CT screening to detect lung cancer. I am not suggesting that the CT screening should not be commissioned (with NSC approval). But it does appear at first sight to be perverse to decommission stop smoking services, at least in part due to funding cuts to public health services, while investing in this screening programme through the NHS.
Jumping the gun? The search for evidence of cost effectiveness in lung cancer screening using low-dose computed tomography
Dear Editors
Upon reading this news item, some readers may have concluded that low-dose computed tomography (LDCT) is now the accepted norm for lung cancer screening for high risk group.
However I have difficulty confirming this is the case, particularly when the UK Lung Cancer Screening Trial (UKLS) have yet to verify the cost effectiveness of this screening mode taking into account the magnitude of mortality reduction, rather than early detection of lung cancer alone.
Despite much touted plans to pool UKLS data with " NELSON (Nederlands Leuvens Longkanker Screenings Onderzoek: Dutch-Belgian Randomised Lung Cancer Screening Trial) and other European Union trials" (by 2017 - Ref 1) for optimal balance of disease mortality versus cost effectiveness, I have difficulty finding out if this has occurred; certainly conclusion of these analyses are yet unavailable to the wider public.
As such I am concerned that NHS England may have invested in a LDCT lung screening program whose cost effectiveness is yet to be proven; a perplexing situation at the time of NHS austerity, health budget uncertainty and cost cutting of public health services.
Professor Richard Sullivan is correct to flag the obsession of using expensive "new" technology in screening for cancer when "there are many other factors to consider", the issue of overdiagnosis and associated investigation/ intervention mortality and morbidity is not insignificant when dealing with large population numbers.
Reference:
1. https://www.ncbi.nlm.nih.gov/pubmed/27224642
Competing interests: No competing interests