Introduction Lung cancer typically presents at an advanced stage when it is associated with poor survival. Screening asymptomatic patients at high risk of lung cancer has been shown to reduce lung cancer mortality. In partnership with the West Yorkshire and Harrogate Cancer Alliance we conducted a community based targeted lung health check (LHC) pilot programme in Wakefield. Here we report our baseline cancer related outcomes. Methods Ever smokers aged 55 to 75 registered at three large GP practices in deprived areas in Wakefield were invited to a community based LHC. They were assessed for symptoms and offered spirometry and smoking cessation. Lung cancer risk was assessed using the PLCOm2012 tool. Those patients whose risk was ≥ 1.51% were offered a low dose CT (LDCT) on a mobile scanning unit within the local community. CT scan reports indicating possible lung cancer were referred directly to the diagnostic lung cancer MDT and the fast track clinic. Results Of the eligible population, 1990 patients underwent a LHC and 697 proceeded to LDCT. 17 (2.4%) were diagnosed with lung cancer. 10 (58.8%) of cancers were diagnosed at stage I and II. Stage distribution is shown in figure 1. Adenocarcinoma was the most common histological subtype in 6 (35.2%) patients. Other histology included; squamous cell carcinoma 3 (17.6%), small cell 2 (11.6%), carcinoid 2 (11.6%) and 1 (5.8%) mucoepidermoid carcinoma. In 3 (17.6%) the diagnosis of lung cancer was made on radiological grounds by the MDT. Radical intent treatment was delivered to 15 (88.2%) of the 17 cancers. Modalities included; surgery 9 (52.9%), radical radiotherapy 3 (17.6%), chemoradiotherapy 2 (11.7%) and SABR 1 (5.8%). Two patients received best supportive care including palliative care. 183 (26.2%) patients had indeterminate scans with pulmonary nodules requiring surveillance. Conclusion Community based Targeted LHC is an effective way of diagnosing lung cancer at an earlier stage. This leads to more patients receiving curative intent treatment and potentially improves outcomes. Whilst we are not able to demonstrate a survival advantage in this small group, the trends are encouraging in indicating a shift towards early diagnosis.

IntroductionThe Targeted Lung Health Check Programme is being rolled out nationally with the primary aim of detecting early stage lung cancer in high risk individuals using low dose CT (LDCT). These scans can also detect other pulmonary or extra-pulmonary findings, which could potentially require further management or specialist referral. We aim to identify the prevalence of these additional findings in a community based Lung Health Check Pilot.MethodsEver smokers between the ages of 55 and 75 were invited for a lung health check including a risk assessment for lung cancer using a standardised tool. If they were considered to be at high risk of lung cancer, they were invited for a LDCT. Significant other findings requiring further review and action were highlighted by radiologists using a coding system. Potential lung cancer and pulmonary nodules were excluded from this analysis. CT scan reports of all patients who underwent a LDCT as part of the pilot were reviewed. We identified all additional pulmonary and extra-pulmonary findings described, irrespective of whether further action was recommended or not. The proportion of additional findings coded as significant by radiology was documented.ResultsOut of the total 697 patients, 440 (63.1%) had additional findings documented on their LDCT reports. 53.8% of patients had pulmonary findings, the majority of which were emphysema (40.3% of all patients). Inflammatory changes/atelectasis (11.3%) was the next most common finding. Extra-pulmonary findings were documented in 135 patients (19.4%). Adrenal abnormalities (5.5% of all patients) were the most common followed by musculoskeletal abnormalities (3.6%), which included osteoporosis and bone lesions. Out of the 440 patients with other (pulmonary or extra-pulmonary) findings, 163 (37.0%) were highlighted according to the radiology reporting protocol as significant findings requiring further assessment or intervention.ConclusionsThe Lung Health Check programme provides a good opportunity for identifying other significant pulmonary and extra-pulmonary findings in this patient group, which may not have otherwise come to light. The influence of this on clinical services needs to be further evaluated as there will be an impact on resources.

Introduction Low-dose CT screening for lung cancer is now available in North America according to criteria based on those used in the National Lung Screening Trial (NLST). Composite lung cancer risk prediction tools may increase the proportion of lung cancer patients eligible for screening. Our previous analysis1 reported the proportion of lung cancer patients eligible for screening according to various criteria at the time of diagnosis. However, of more relevance is eligibility some time prior to diagnosis when early detection and treatment may reduce mortality. Based on an estimated sojourn time of 4 years, we assessed eligibility for screening 2 years prior to diagnosis. Methods This is an extension of our previously published cohort1 prospectively recruited from lung cancer fast-track clinics in West Yorkshire (Bradford, Calderdale and Huddersfield, Leeds, Mid-Yorkshire) from January–December 2016. Data was collected to allow assessment for eligibility according to the NLST criteria, USPSTF criteria (NLST extended to 80 years) and calculation (for ever-smokers) of lung cancer risk according to the Prostate Lung Colorectal and Ovarian score (PLCOM2012) and the Liverpool Lung Project score (LLP v2) 2 years prior to diagnosis. Results 347 patients with lung cancer were identified of which 16 were excluded due to incomplete data collection. The percentage of lung cancer patients who would have been eligible by USPSTF and NLST criteria, together with percentages eligible at various thresholds of the two scores are shown in figure 1. The proportion of patients eligible 2 years prior to diagnosis were 35% for NLST, 46% for USPSTF, 59% for PLCO≥1.51% (55–75 year), and 34% for LLP ≥5% (55–75 year). 11% of patients would have been <55 years, 31%>75 years and 12%>80 years. 7% of those aged 55–80 years were never smokers. Discussion The percentage of patients eligible for screening differs widely between potential screening criteria. If screening were available for a 55–75 year target age group, the majority of lung cancer patients would not have been eligible two years prior to their diagnosis using either NLST or USPSTF criteria and at almost all thresholds of the two risk scores. Reference Gracie, et al. Thorax2016;71(Suppl 3):A76.

The US National Lung Screening Trial (NLST) identified persons for lung cancer screening by age (55–74 yrs) and smoking history, but a subsequent analysis of the US SEER database showed that only 26.7% of lung cancer cases would have been eligible for screening according to these criteria. Strategies to increase the proportion of lung cancer patients who might qualify for screening include increasing the upper age limit to 80 years (endorsed by the US Preventative Services Task Force – USPSTF), and using composite lung cancer risk prediction tools. The UK Lung Screening pilot (UKLS) used the Liverpool Lung Project score (LLP) to identify patients for screening. In a validation cohort from the US Prostate, Lung, Colorectal and Ovarian study, a threshold based on the PLCOM2012 score identified more cancers than the NLST criteria. We prospectively compared these criteria for the first time in patients presenting with lung cancer in Yorkshire. Methods We audited the proportion of patients presenting with lung cancer through fast-track clinics at 4 Yorkshire centres who would have been eligible for screening according to the following criteria: NLST criteria, UKLS criteria, USPSTF criteria, LLP ≥5% 55–80 yrs, and PLCO ≥1.51% 55–80 yrs. Results Data was collected for 206 patients presenting between January and July 2016 (Leeds 131, Halifax 26, Bradford 12, Mid-Yorkshire 37). Median age was 72 years and the proportion of cases by age cohort was as follows: <55 yrs 9.2%, 55–60 yrs 9.7%, 61–65 yrs 12.1%, 66–70 yrs 13.6%, 71–75 yrs 18.4%, 76–80 yrs 17.0%, >80 yrs 19.9%. Smoking status was: current smoker 89 (43.2%), ex-smoker 106 (51.5%) and never smoker 11 (5.3%). The number of patients eligible by the various criteria are shown in Table 1. Conclusion The proportion of lung cancer patients who would have been eligible for screening differs considerably between the various criteria. Only approximately one third of patients would have been eligible according to the criteria used in NLST and UKLS. Increasing the upper age limit for screening to 80yrs substantially increases the proportion of cases that would be eligible. A threshold of 1.51% by the PLCOM2012 score included the largest number of lung cancer patients of the criteria assessed.