Mobile lung cancer testing in supermarket car parks is to be expandedBMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5450 (Published 23 November 2017) Cite this as: BMJ 2017;359:j5450
A successful pilot scheme to detect lung cancer at an early stage by offering smokers and former smokers computerised tomography scanning in shopping area car parks is to be rolled out more widely.
Simon Stevens, chief executive of NHS England, announced the expansion of the scheme at the Economist’s War on Cancer conference in London on 21 November.
“One of the main things the NHS needs to focus on is early diagnosis in order to improve outcomes,” he told the conference. “The Manchester pilot scheme offering mobile CT scans in community supermarkets found that one in 33 people who walked in off the street had early cancer.”
The pilot scheme sited mobile, low dose CT scanners in three deprived areas of Manchester. Patients aged between 55 and 74 with a history of smoking were sent a letter from their GP asking them to attend. More than 2500 people underwent spirometry tests and answered questions about their health, and about half were offered an immediate CT scan during the three month pilot scheme.
The scans led to 46 cases of cancer being discovered, 80% of which were at stages I and II. Less than 20% of cases are diagnosed at these stages through the usual care pathways after symptoms are reported. The proportion discovered at stage IV was just over 10%, which compares with nearly 50% through usual care pathways. The scheme also resulted in diagnoses of chronic obstructive pulmonary disease in 20% of those attending.
The pilot scheme, funded by the Manchester Clinical Commissioning Groups through the Macmillan Cancer Improvement Partnership and Macmillan Cancer Support, is now being rolled out across the whole of north Manchester. Manchester has England’s highest rates of premature mortality from lung cancer.
NHS England said that other cancer alliances that will be rolling out similar schemes include Humber Coast and Vale, RM Partners (North West and South West London), and Northern (North East and Cumbria).
Stevens was asked whether the fact that scans were now being offered in supermarket car parks meant that GPs could now be trusted to order CT scans directly. He replied, “Potentially, yes, but we will be guided by the National Screening Committee.”
Stevens also announced that over the next 18 months NHS England would be rolling out faecal immunochemical test (FIT) home testing kits to improve the early detection of bowel cancer. The plan is for FIT tests to be sent to everyone between the ages of 60 and 74 every two years.
The FIT kit comprises a small plastic container with a stick attached to the lid. Patients collect a sample by scraping the tip of the stick along the bowel motion and sending the kit in return freepost packaging for analysis. The FIT test can detect low concentrations of blood in a faecal sample. Only one faecal sample is needed, in contrast to the guaiac faecal occult blood test, which needs six samples from three bowel motions.
Speaking at the conference, Richard Sullivan, professor of cancer and global health at King’s College London, pointed out that expensive screening tools weren’t the only answer when it came to early detection of cancer. “Sometimes we get carried away thinking that technology is going to be the panacea, but there are many other factors to consider,” he said.
It was important to reduce the high number of people who presented in hospital emergency departments with stage III and IV bowel cancer, for example, and who had no knowledge of the early signs of the disease, he added.
Factors such as inequality and social deprivation were also a “massive issue that we don’t talk about,” he said.