Early diagnosis of lung cancer: is rapid access CT scanning the answer?

INTRODUCTION

Lung cancer remains the most common cause of cancer mortality in Britain. The 10-year survival rate from the disease is in the order of 5%, because the majority of patients present with advanced disease. Five-year survival rates for lung cancer in the UK from 2000–2014 are only 13%, lagging far behind most other EU nations. These findings, which were published in the Lancet in January 2018, have also been widely reported in many national newspapers.¹

Currently, the US, Canada, and a number of European countries have implemented screening programmes for lung cancer with low-dose computed tomography (CT). Early diagnosis by low-dose CT (LDCT) screening has been shown to lead to a reduction in lung cancer mortality by 20% in the National Lung Screening Trial (NLST), a large randomised clinical trial from the US.² The final results from the Dutch-Belgian NELSON trial, the only other clinical study powered to detect a reduction in mortality, are still awaited.³

The Accelerate, Coordinate, Evaluate (ACE) Programme was funded by Cancer Research UK and Macmillan Cancer Support, and took place between 2014 and 2017. The final ACE report was published in April 2017.⁴ Although not funding local screening programmes as such, the ACE programme was an important early diagnostic cancer initiative focused on evaluating a wide variety of innovations designed to either streamline diagnostic pathways or identify individuals at an increased risk of cancer.⁵

One strand of ACE was the lung cancer cluster, which aimed to explore the most …