A pilot program in Britain in which thousands of people were screened for lung cancer in a supermarket parking lot using portable CT resulted in a significant increase in earlier diagnoses. Now the program is to be rolled out across more centers as part of a national cancer program.
The move, which was announced November 21 at the War on Cancer 2017 meeting in London, follows numerous reports in recent years that the United Kingdom lags behind other European countries in terms of cancer survival and access to treatment.
Alongside the lung cancer screening initiative, the National Health Service (NHS) in England plans to make a simple and inexpensive colorectal cancer test ― a fecal immunoglobulin test (FIT) for home use ― more widely available. It also has developed a pilot program in which MRI will be used to speed the diagnosis of prostate cancer.
The three new initiatives, taken together, will expand cancer screening to 4 million people in 2018, the NHS says.
“Over the next 18 months, the NHS will be rolling out new mobile and home screening kits to detect cancers earlier, when they can be treated best,” said Simon Stevens, chief executive of the NHS, in a press release.
Screening for Lung Cancer
The lung cancer screening rollout follows a highly successful pilot project in north Manchester, which has the highest incidence of lung cancer in England.
Through the pilot program, 80% of the lung cancer cases that were detected were of stage I or II disease. The rate of stage IV cancers that were identified in primary care fell from almost half to just over 1 in 10, according to the NHS
As previously reported by Medscape Medical News, all smokers and exsmokers were invited to have a free lung health check in a supermarket parking lot. A nurse who specializes in pulmonary disease led a discussion about symptoms, spirometry, and individual lung cancer risk assessment.
Those at high risk were offered an immediate low-dose CT examination; those at lower risk but who had symptoms were asked to contact their general practitioner.
Of more than 2500 people aged 55 to 74 years who attended the screening, half were women, and one third were current smokers. Around half of attendees were offered immediate CT screening, which lead to 42 cancer diagnoses, at a rate of 1 per 33 CT scans.
The scheme, which is funded by the UK charity Macmillan Cancer Support via the Macmillan Cancer Improvement Partnership in Manchester, is now going to be rolled out across the whole of north Manchester as part of a national plan to diagnose cancers earlier.
Paula Chadwick, chief executive at the Roy Castle Lung Cancer Foundation, commented in a release: “Having seen the impact NHS screening programs have had for cervical, breast, and bowel cancer, we are hopeful these [screening tests] could be a pivotal first step in seeing a similar program introduced for lung cancer.
“If we can spot lung cancer early, we can save lives; so these schemes could help to save thousands of lives across the UK,” she added.
Dany Bell, specialist advisor for treatment and recovery at Macmillan Cancer Support, said in the Telegraph: “The earlier that someone is diagnosed with cancer, the better their chance of successful treatment is.
“Lung cancer is a notoriously difficult type to diagnose at an early stage, and initiatives such as this make it easier for high-risk people to get their health checked,” she added.
New Scheme for Prostate Cancer
Another of the new initiatives is a pilot program that hopes to revolutionize the way that prostate cancer is diagnosed. The program is intended to reduce unnecessary invasive tests and speed access to treatment.
The initiative involves use of a high-definition MRI examination in conjunction with a clinical review and, if necessary, a targeted biopsy, all of which are performed on the same day. The aim is to slash the average time to prostate cancer diagnosis to 8 days and to reduce the time from referral to treatment to 20 days.
The initiative is funded by the National Cancer Transformation Program and is being tested in three London hospitals. It builds on research showing that use of high-definition MRI doubles the likelihood of identifying life-threatening prostate cancers.
A third initiative involves increasing the availability of an easy-to-use home testing kit for colorectal cancer. Use of the kit can rule out the disease in patients with abdominal symptoms.
This FIT-based product will be rolled out across the NHS in 2018. The hope is that it will increase the number of colorectal cancer diagnoses by 1500 each year and will help to identify cases at an earlier stage of the disease, when they are more treatable. In addition, use of the home-based FIT test could reduce healthcare spending, as noted a report in the Independent . Use of the test could allow around 100,000 patients per year to avoid colonoscopy, with huge savings in cost. The home test costs around £5 (~$6.60), whereas a colonoscopy costs £372 (~$490).
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