title: CT screening for lung cancer: Is the evidence strong enough?
abstract: The prevailing questions at this time in both the public mind and the clinical establishment is, do we have sufficient evidence to implement lung cancer Computed Tomography (CT) screening in Europe? If not, what is outstanding? This review addresses the twelve major areas, which are critical to any decision to implement CT screening and where we need to assess whether we have sufficient evidence to proceed to a recommendation for implementation in Europe. The readiness level of these twelve categories in 2015 have been with colour coded, where green indicates we have sufficient evidence, amber is borderline evidence and red requires further evidence. Recruitment from the 'Hard to Reach' community still remains at red, while mortality data, cost effectiveness and screening interval are all categorised as amber. The integration of smoking cessation into CT screening programmes is still considered to be category amber. The US Preventive Services Task Force have recommended that CT screening is implemented in the USA utilising the NLST criteria, apart from continuing screening to 80 years of age. The cost effectiveness of the NLST was calculated to be $81,000/QALY, however, its well recognised that the costs of medical care in the USA, is far higher than that of Europe. Medicare have agreed to cover the cost of screening but have stipulated a number of stringent requirements for inclusion. To date we do not have good CT screening mortality data available in Europe and eagerly await the publication of the NELSON trial data in 2016 and then the pooled UKLS and NELSON data thereafter. However in the meantime we should start planning for implementation in Europe, especially in the areas of the radiological service provision and accreditation, as well as identifying novel mechanisms to recruit from the hardest to reach communities.
authors.affiliation: Roy Castle Lung Cancer Research Programme, The University of Liverpool, Department of Molecular and Clinical Cancer Medicine, The Apex Building 6 West Derby Street, Liverpool L7 8TX, UK. Electronic address: J.K.Field@liv.ac.uk.
authors.forename: J K
authors.initials: JK
authors.lastname: Field
authors.affiliation: Department of Radiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. Electronic address: A.Devaraj@rbht.nhs.uk.
authors.forename: A
authors.initials: A
authors.lastname: Devaraj
authors.affiliation: Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK. Electronic address: s.w.duffy@qmul.ac.uk.
authors.forename: S W
authors.initials: SW
authors.lastname: Duffy
authors.affiliation: Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals, City Campus, Hucknall Road, Nottingham NG5 1PB, UK. Electronic address: david.baldwin@nuh.nhs.uk.
authors.forename: D R
authors.initials: DR
authors.lastname: Baldwin
mesh_terms: D000368:Aged; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D014481:United States / Q000453:epidemiology
keywords: Low dose computed tomography; Lung cancer screening; Mortality & cost effectiveness; Recruitment & risk modelling; Smoking cessation; Volumetric analysis of CT scans