Introduction Lung cancer screening (LCS) with low-dose CT offers a teachable moment for smoking cessation (SC), but the optimal way to implement SC within LCS is unclear. The Yorkshire Enhanced Stop Smoking (YESS) study assessed the efficacy of a personalised stop-smoking intervention delivered alongside LCS.Methods Opt-out, co-located SC support, comprising nicotine replacement therapy/e-cigarettes/pharmacotherapy and behavioural support, was offered to all individuals who currently smoked attending for LCS. Four weeks later, participants were offered recruitment to a randomised controlled trial of continued standard best practice (SBP) versus a personalised SC support package, including a booklet containing CT images of participants' own heart and lungs, annotated where appropriate to highlight emphysema or coronary artery calcification and scripted communication delivered by a smoking cessation practitioner.Results 1003 people were recruited; 52.5% were allocated to the intervention group. Validated 7-day point prevalent (PP) abstinence rates were 33.6% and 30.0% in the intervention versus SBP groups, respectively (OR 1.17, 95% CI 0.90 to 1.54) at 3 months and 29.2% versus 28.6% (OR 1.03, 95% CI 0.78 to 1.36) at 12 months post-screening. Subgroup analyses indicated a significant increase in 7-day PP abstinence at 3 months with the intervention in women (33.9% intervention, 23.1% SBP, OR 1.70, 95% CI 1.15 to 2.53) but not in men (33.3% intervention, 37.8% SBP, OR 0.82, 95% CI 0.57 to 1.19).Conclusion Around one-third of study participants were abstinent from smoking at 3 months post-screening irrespective of study arm, but adding the personalised intervention did not increase quit rates. Further research is needed exploring possible sex differences in efficacy of personalised SC support. The high overall quit rate reinforces the value of SC support delivered alongside LCS.Trial registration number ISRCRN 63825779 and NCT03750110.

BACKGROUND:Lung cancer screening is effective for people at higher risk of the disease, but there is no international consensus on eligibility criteria. Some programmes use risk factors; others use multivariable risk scores, which might target an older, more comorbid population and thus limit life years gained. In this study, we compare frailty, comorbidities and overall survival between different eligible populations. METHODS:Participants aged 55-74 years undergoing lung cancer risk assessment in the Yorkshire Lung Screening Trial were analysed, comparing those who met the US Preventive Services Task Force 2021 lung cancer screening criteria (USPSTF2021) criteria against established risk-based criteria currently used in screening protocols (Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial risk model (PLCOm2012) ≥1.51%, used internationally, and the Liverpool Lung Project risk model (version 2) (LLPv2) ≥2.5%, used in the UK), examining the number of individuals with frailty and comorbidities selected by each approach. In addition, risk score thresholds were set to select equivalent numbers of people screened compared with USPSTF2021. Data recorded in primary care prior to randomisation were retrospectively extracted to allow calculation of the electronic Frailty Index (eFI) and an overall comorbidity count. Frailty, comorbidity counts and 3-year overall survival were compared between these various populations. RESULTS:Of 11 994 individuals aged 55-74 undergoing risk assessment, 3502 were eligible by USPSTF2021, 3139 by PLCOm2012 ≥1.51% and 3957 by LLPv2 ≥2.5%. The proportion of individuals with moderate/severe frailty was lower for the USPSTF2021 population (10.6%) compared with PLCOm2012 ≥1.51% (13.1%, adjusted p=0.0777) and LLPv2 ≥2.5% (13.4%, adjusted p=0.0272). The USPSTF2021 identified significantly fewer individuals with multiple comorbidities (30.8%) than the PLCOm2012 (36.1%, adjusted p=0.0033) and the LLPv2 (37.3%, adjusted p=0.0001).When compared in equivalent populations, both PLCOm2012 with a threshold of 1.32%, and LLPv2 with a threshold of 2.92%, had a higher proportion of people both with moderate/severe frailty (12.6%, adjusted p=0.221 and 14.0%, adjusted p=0.0067 respectively) and multiple comorbidities (35.1%, adjusted p=0.0211 and 38.5%, adjusted p<0.0001 respectively) than USPSTF2021.There were no apparent differences in 3-year overall survival between the eligible populations overlapping 95% CIs across risk groups. CONCLUSION:These data suggest that currently used risk models identify populations with a small increase in moderate/severe frailty and multimorbidity compared to the USPSTF2021 criteria, but there is no evidence to suggest that this results in differences in 3-year overall survival.

BACKGROUND:Lung cancer (LC) is the most common cause of cancer death in the UK and worldwide, but screening with low-dose CT (LDCT) reduces LC deaths. The UK National Screening Committee has recommended nationwide roll-out of LDCT screening, but the optimal risk thresholds for eligibility remain uncertain. METHODS:We conducted a cost-effectiveness analysis in the Yorkshire Lung Screening Trial (YLST) population comparing three eligibility criteria: US Preventive Services Task Force (USPSTF)2013, Prostate Lung Colorectal and Ovarian study (PLCO)M2012 ≥1.51% and Liverpool Lung Project model (LLP)v2 ≥5%. A Markov model estimated a no-screening counterfactual. Scenario analyses assessed how increasing PLCOM2012 (1.51%-7%) and LLPv2 (5%-9%) thresholds affected LC detection, costs and quality-adjusted life years (QALYs). Payouts per detected LC were calculated using mortality and utility estimates from the literature and cost data from the trial. RESULTS:Incremental cost-effectiveness ratios (ICERs) versus no screening were £3949 (USPSTF2013), £3797 (LLPv2≥5%) and £4013 (PLCOM2012≥1.51%). PLCOM2012 yielded the largest numbers screened and LCs detected, most QALYs gained and highest incremental net monetary benefit. Raising LLPv2 and PLCOM2012 thresholds reduced both ICERs and QALYs gained. CONCLUSION:All three screening eligibility criteria are cost-effective according to the UK's willingness to pay threshold of £20 000/QALY. Within the range of thresholds observed in YLST, PLCOM2012 thresholds between ≥1.51% and ≥4% offered the most efficient cost-benefit trade-offs. Evidence suggests that lowering thresholds further would detect more LC cases while remaining cost-effective. These findings support the criteria implemented in YLST, but do not by themselves identify the optimal screening threshold for the wider UK population. TRIAL REGISTRATION NUMBER:ISRCTN42704678.

Background and objective: The Yorkshire Kidney Screening Trial (YKST) assessed the feasibility of adding abdominal noncontrast computed tomography (NCCT) to lung cancer screening to screen for kidney cancer and other abdominal pathology. Methods: A prospective diagnostic study offered abdominal NCCT to 55-80-yr-old ever-smokers attending a UK randomised lung cancer screening trial (May 2021 to October 2022). The exclusion criteria were dementia, frailty, previous kidney/lung cancer, and computed tomography (CT) of the abdomen and thorax within previous 6 and 12 mo, respectively. Six-month follow-up was undertaken. Key findings and limitations: A total of 4438 people attended lung screening, of whom 4309 (97%) were eligible for and 4019 (93%) accepted abdominal NCCT. Only 3.9% respondents regretted participating. The additional time to conduct the YKST processes was 13.3 min. Of the participants, 2586 (64%) had a normal abdominal NCCT, whilst 787 (20%) required an abdominal NCCT imaging review but no further action and 611 (15%) required further evaluation (investigations and/or clinic). Of the participants, 211 (5.3%) had a new serious finding, including 25 (0.62%) with a renal mass/complex cyst, of whom ten (0.25%) had histologically proven kidney cancer; ten (0.25%) with other cancers; and 60 (1.5%) with abdominal aortic aneurysms (AAAs). Twenty-five (0.62%) participants had treatment with curative intent. Of the participants, 1017 (25%) had nonserious findings, most commonly benign renal cysts (727 [18%]), whereas only 259 (6.4%) had nonserious findings requiring further tests. The number needed to screen to detect one serious abdominal finding was 18; it was 93 to detect one suspicious renal lesion and 402 to detect one histologically confirmed renal cancer. Limitations of the cohort were fixed age range and being prior lung cancer screening attendees. Conclusions and clinical implications: In this first prospective risk-stratified screening study of abdominal NCCT offered alongside CT thorax, uptake and participant satisfaction were high. The prevalence of serious findings, cancers, and AAAs, is in the range of established screening programmes such as bowel cancer. Longer-term outcomes and cost effectiveness should now be evaluated. (c) 2024 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).

Kidney cancer (KC) screening may be facilitated by targeting individuals at a higher risk and combining with other screening programmes. Previous estimates of the prevalence of screen-detected KC are outdated and do not enable an accurate assessment in a high-risk group. The Yorkshire Kidney Screening Trial (YKST) is a unique study of the feasibility of adding KC screening via an abdominal noncontrast computed tomography (CT) scan to the thoracic low-dose CT within a targeted lung cancer screening trial in ever smokers (Yorkshire Lung Screening Trial; YLST). Seventeen histologically confirmed KC cases were detected on thoracic CT in YLST (N = 6650; prevalence 0.26%; 95% confidence interval [CI] 0.15-0.41%), which has implications for future service planning to accommodate the investigation and treatment of screen-detected KC patients following the national adoption of lung cancer screening. Adding abdominal CT in YKST (n = 4019) identified an additional ten histologically confirmed KC patients (prevalence 0.25%; 95% CI 0.12-0.46%). In summary, using data from YKST, we report the first contemporary estimates of the prevalence of KC in high-risk individuals, key data required to plan future prospective screening studies.

BackgroundLow-dose computed tomography screening reduces lung cancer-specific mortality in high-risk individuals. Lung cancer risk factors overlap with comorbid diseases, highlighting the significance of frailty and comorbidities for lung cancer screening (LCS). Here, we describe the prevalence of frailty and comorbidity in those invited for LCS and evaluate their associations with response to telephone risk assessment invitation and subsequent uptake of LCS.MethodsAnalysis was based on the intervention arm of the Yorkshire Lung Screening Trial, where ever-smoked individuals aged 55-80 were invited to telephone risk assessment followed by community-based LCS if at higher risk. The electronic frailty index (eFI) was used to compute individual frailty scores (categorised as fit, mild, moderate and severe) and derive comorbidity data.ResultsOf 27,761 individuals invited, 24.1% (n = 6702), 8.5% (n = 2353) and 1.7% (n = 459) had mild, moderate and severe frailty, respectively. Over half responded to the invitation to telephone risk assessment (n = 14,523, 52.5%) with frailty associated with a higher response rate compared to fit individuals: adjusted odds ratio (ORadj) 1.34, 95% confidence interval (CI) 1.26-1.42 for mild frailty; ORadj 1.28, 95%CI 1.16-1.40 for moderate frailty; and ORadj 1.32, 95%CI 1.08-1.61 for severe frailty. Similar patterns were seen with comorbidity counts. After assessment, moderate (ORadj 0.75, 95%CI 0.59-0.96) and severe (ORadj 0.67, 95%CI 0.43-1.04) frailty were associated with reduced screening uptake.ConclusionThe presence of frailty was associated with increased response to LCS invitation. Given the strong association between frailty and reduced life expectancy, these results suggest that people with potentially more life years to be gained from LCS may be less inclined to take part. Further research is needed to explore the interactions between frailty and LCS decision-making to inform future invitation strategies.

INTRODUCTION:Lung cancer screening saves lives by detecting cancers early, but continued adherence to screening rounds is required for participants to experience the maximum clinical benefit. Here we describe factors associated with screening adherence in the Yorkshire Lung Screening Trial. METHODS:All eligible individuals following baseline (prevalent) screening were invited for a biennial incident screen in a community setting. Participants were contacted by phone (up to two attempts) to arrange an appointment or sent a pre-arranged appointment letter if non-contactable. Characteristics of attenders versus non-attenders were compared using univariate and multivariable models. RESULTS:Of 6,650 individuals who attended baseline screening, 5,975 were eligible for the second round. The mean age of those eligible was 70.5 years, 45.2 % were female, 31.7 % were from the most socio-economically deprived quintile and 33.9 % reported current smoking at the time of the baseline scan. Of these, 5,184 (86.8 %) attended their second screen and 791 (13.2 %) did not. Factors associated with lower attendance following multivariable analysis were socio-economic deprivation (OR 0.78, 95 % CI 0.60-1.02, most versus least deprived quintile) and current smoking (OR 0.57, 95 % CI 0.48-0.66, current versus previously quit). Sex, age, and ethnicity were not associated with attendance. Attendance was more likely in people who had an indeterminate (OR 2.10, 95 % CI 1.61-2.73; n = 871) or positive (OR 3.16, 95 % CI 0.98-10.19; n = 60) baseline scan compared to a negative baseline scan. DISCUSSION:Adherence was good overall but lower adherence amongst people who currently smoke and those from deprived populations is a concern due to their greater risk of lung cancer death. Further research is needed into interventions that increase adherence in these high-risk populations.

INTRODUCTION:Low-dose computed tomography screening for lung cancer reduces lung cancer mortality, but there is a lack of international consensus regarding the optimal eligibility criteria for screening. The Yorkshire Lung Screening Trial was designed to evaluate lung cancer screening (LCS) implementation, and a primary objective was prospective evaluation of three predefined eligibility criteria. METHODS:Individuals who had ever smoked, aged 55 to 80 years, who responded to written invitation, underwent telephone risk assessment and if eligible by at least one criterion (PLCOM2012 ≥ 1.51%, LLPv2 ≥ 5%, USPSTF2013) were offered biennial low-dose computed tomography screening. RESULTS:Of 44,957 individuals invited, 22,814 responded and underwent eligibility assessment, of whom a total of 7826 were eligible according to any of the three LCS criteria. Comparing PLCOM2012 ≥ 1.51%, LLPv2 ≥ 5%, and USPSTF2013, the proportions of responders eligible for screening were 28.0%, 20.5%, and 18.9%, respectively (p < 0.0001 for each comparison), and the proportion of all cancers detected 91.1%, 77.0%, and 62.8%, respectively (p ≤ 0.0002 for each comparison). When risk thresholds were selected to result in equivalent numbers of people eligible for screening, cancer detection proportions were higher for PLCOM2012 (74.5%) and LLPv2 (71.3%) than USPSTF2013 (62.8%) (p = 0.0002 and p = 0.032, respectively), but there was no significant difference between the two risk models. Reducing the LLPv2 risk threshold from 5% to 2.5% (as currently used in the English LCS program) and reducing the pack-year requirement for the USPSTF2021 versus the USPSTF2013 criteria increased the numbers eligible for screening, but subsequent cancer yield was not measured in this study. CONCLUSION:The PLCOM2012 ≥ 1.51% criteria identified more people eligible for screening in Yorkshire Lung Screening Trial and resulted in more screen-detected lung cancers than LLPv2 ≥ 5% or USPSTF2013. When compared in equivalent populations, there was no significant difference between risk models in terms of lung cancer detection and each appeared more efficient at screening population selection than USPSTF2013.

Introduction Lung cancer is the most common cause of cancer death globally. In 2022 the UK National Screening Committee recommended the implementation of a national targeted lung cancer screening programme, aiming to improve early diagnosis and survival rates. Research studies and services internationally consistently observe socioeconomic and smoking-related inequalities in screening uptake. Pathway navigation (PN) is a process through which a trained pathway navigator guides people to overcome barriers to accessing healthcare services, including screening. This nested randomised controlled trial aims to determine whether a PN intervention results in more individuals participating in lung cancer screening compared with the usual written invitation within a previous non-responder population as part of the Yorkshire Lung Screening Trial (YLST).Methods and analysis A two-arm randomised controlled trial and process evaluation nested within the YLST. Participants aged 55–80 (inclusive) who have not responded to previous postal invitations to screening will be randomised by household to receive PN or usual care (a further postal invitation to contact the screening service for a lung health check) between March 2023 and October 2024. The PN intervention includes a postal appointment notification and prearranged telephone appointment, during which a pathway navigator telephones the participant, following a four-step protocol to introduce the offer and conduct an initial risk assessment. If eligible, participants are invited to book a low-dose CT (LDCT) lung cancer screening scan. All pathway navigators receive training from behavioural psychologists on motivational interviewing and communication techniques to elicit barriers to screening attendance and offer solutions.Coprimary outcomes The number undergoing initial telephone assessment of lung cancer risk. The number undergoing an LDCT screening scan.Secondary outcomes include demographic, clinical and risk parameters of people undergoing telephone risk assessment; the number of people eligible for screening following telephone risk assessment; the number of screen-detected cancers diagnosed; costs and a mixed-methods process evaluation.Descriptive analyses will be used to present numbers, proportions and quantitative components of the process evaluation. Primary comparisons of differences between groups will be made using logistic regression. Applied thematic analysis will be used to interpret qualitative data within a conceptual framework based on the COM-B framework. A health economic analysis of the PN intervention will also be conducted.Ethics and dissemination The study is approved by the Greater Manchester West Research Ethics Committee (18-NW-0012) and the Health Research Authority following the Confidentiality Advisory Group review. Results will be shared through peer-reviewed scientific journals, conference presentations and on the YLST website.Trial registration numbers ISRCTN42704678 and NCT03750110.

BackgroundUp to 50% of those attending for low-dose computed tomography screening for lung cancer continue to smoke and co-delivery of smoking cessation services alongside screening may maximise clinical benefit. Here we present data from an opt-out co-located smoking cessation service delivered alongside the Yorkshire Lung Screening Trial (YLST).MethodsEligible YLST participants were offered an immediate consultation with a smoking cessation practitioner (SCP) at their screening visit with ongoing smoking cessation support over subsequent weeks.ResultsOf 2150 eligible participants, 1905 (89%) accepted the offer of an SCP consultation during their initial visit, with 1609 (75%) receiving ongoing smoking cessation support over subsequent weeks. Uptake of ongoing support was not associated with age, ethnicity, deprivation or educational level in multivariable analyses, although men were less likely to engage (adjusted OR (ORadj) 0.71, 95% CI 0.56–0.89). Uptake was higher in those with higher nicotine dependency, motivation to stop smoking and self-efficacy for quitting. Overall, 323 participants self-reported quitting at 4 weeks (15.0% of the eligible population); 266 were validated by exhaled carbon monoxide (12.4%). Multivariable analyses of eligible smokers suggested 4-week quitting was more likely in men (ORadj1.43, 95% CI 1.11–1.84), those with higher motivation to quit and previous quit attempts, while those with a stronger smoking habit in terms of cigarettes per day were less likely to quit.ConclusionsThere was high uptake for co-located opt-out smoking cessation support across a wide range of participant demographics. Protected funding for integrated smoking cessation services should be considered to maximise programme equity and benefit.

Data from the ongoing Yorkshire Lung Screening Trial (YLST) indicate that 50% of people invited to a lung cancer screening risk-assessment do not take up the offer, with lowest uptake by people from less affluent areas and who currently smoke. Pathway Navigation (PN) helps individuals overcome barriers to accessing healthcare, particularly among populations disadvantaged by inequalities. This study tests whether PN improves uptake of lung cancer screening compared to normal written invitation within the YLST.

OBJECTIVES:To evaluate psychological, social, and financial outcomes amongst individuals undergoing a non-contrast abdominal computed tomography (CT) scan to screen for kidney cancer and other abdominal malignancies alongside the thoracic CT within lung cancer screening. SUBJECTS AND METHODS:The Yorkshire Kidney Screening Trial (YKST) is a feasibility study of adding a non-contrast abdominal CT scan to the thoracic CT within lung cancer screening. A total of 500 participants within the YKST, comprising all who had an abnormal CT scan and a random sample of one-third of those with a normal scan between 14/03/2022 and 24/08/2022 were sent a questionnaire at 3 and 6 months. Outcomes included the Psychological Consequences Questionnaire (PCQ), the short-form of the Spielberger State-Trait Anxiety Inventory, and the EuroQoL five Dimensions five Levels scale (EQ-5D-5L). Data were analysed using regression adjusting for participant age, sex, socioeconomic status, education, baseline quality of life (EQ-5D-5L), and ethnicity. RESULTS:A total of 380 (76%) participants returned questionnaires at 3 months and 328 (66%) at 6 months. There was no difference in any outcomes between participants with a normal scan and those with abnormal scans requiring no further action. Individuals requiring initial further investigations or referral had higher scores on the negative PCQ than those with normal scans at 3 months (standardised mean difference 0.28 sd, 95% confidence interval 0.01-0.54; P = 0.044). The difference was greater in those with anxiety or depression at baseline. No differences were seen at 6 months. CONCLUSION:Screening for kidney cancer and other abdominal malignancies using abdominal CT alongside the thoracic CT within lung cancer screening is unlikely to cause significant lasting psychosocial or financial harm to participants with incidental findings.