Lung cancer

Dear Editor:

We read with great interest the clinical update on lung cancer and noticed that although the author had mentioned low dose CT screening, it had not been elaborated upon. Despite this we feel advancements in lung cancer screening have been significant enough over the last few years to offer a considerable change in practice and feel it prudent to mention.

Results from the large multi-centre RCT, the National Lung screening trial (NLST), published in 2011 demonstrated a 15-20% reduction in mortality in a high-risk group of patients screened with low-dose helical CT [1]. Since then a screening programme has been rolled out in the USA, with a strict inclusion criteria. The data is compelling enough that the European Position statement has advised that it should be implemented in European countries as soon as viable [2]. In the UK a large trial is currently under way (UKLS). Preliminary results demonstrate that it is possible to detect lung cancer at an early stage and deliver potentially curative treatment in over 80% of cases [3].

For a cancer where early detection is key and smoking cessation has been the only measurable primary prevention technique, screening is a high value public health intervention able to offer early detection and reduced mortality: a change that not only improves patient prognosis but can also reduce healthcare burden.

References:
[1] Reduced lung-cancer mortality with low-dose computed tomographic screening. National Lung Screening Trial Research Team. Aberle DR, Adams AM, Berg CD et al. N Engl J Med. 2011;365(5):395-409.
[2] European position statement on lung cancer screening. M. Oudkerk et al. Lancet Oncol. 2017;18(12):754-766
[3] Lung Cancer RCT Pilot Screening Trial: baseline findings from the screening arm provide evidence for the potential implementation of lung cancer screening. Field JK, Duffy SW, Baldwin DR, et al. UK Thorax 2016;71:161-170.