Delivering low-dose CT screening for lung cancer: a pragmatic approach

Lung cancer kills an estimated 35 000 people in the UK every year. Despite the improvements in treating late-stage disease, lung cancer outcomes have changed little in the last 40 years. Low-dose CT (LDCT) screening for lung cancer reduces lung cancer mortality by 20%–24% and all-cause mortality by 7%.1 2 Lung cancer screening (LCS) however remains contentious, particularly how to implement it in an efficient and efficacious way. This contention extends to the potential costs of screening—financial to the National Health Service (NHS), and physical and psychological harms to patients. These concerns are particularly relevant to how we manage both the findings we aim to detect through screening (pulmonary nodules) and those we pick up inadvertently (incidental findings). The SUMMIT Study is the largest CT screening study in Europe and a key endpoint is detailing the feasibility of delivering CT screening across a complete population within the NHS. We present here SUMMIT’s approach to nodule and incidental findings management, a pragmatic model that is neither overly burdensome nor unsafe and provides a practical solution to some of the challenges of LDCT LCS. The SUMMIT study (ClinicalTrials.gov NCT03934866) is an LCS study recruiting individuals 55–77 years old at high risk of lung and other smoking-related cancers to LDCT screening. Its twin aims are to examine the performance of delivering an LDCT screening service for lung cancer to a high-risk population and to validate a cell-free nucleic acid blood test for detection of multiple cancers. The study began enrolment in April 2019 after the development of protocols for the management of pulmonary nodules and incidental findings that enabled a consistent approach to management across the entirety of the study (target recruitment of 25 000). The study aims to deliver a programme of LCS that is pragmatic, evidence-based, and practically deliverable by …