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Low-Dose Computed Tomography (LDCT) screening for lung cancer can result in several potential outcomes of varying significance. Communication methods used in Lung Cancer Screening (LCS) programmes must, therefore, ensure that participants are prepared for the range of possible results and follow-up. Here, we assess perceptions of a written preparatory information booklet provided to participants in a large LCS cohort designed to convey this information.All participants in the SUMMIT Study (NCT03934866) were provided with a results preparation information booklet, entitled 'The SUMMIT Study: Next Steps' at their baseline appointment which outlined potential results, their significance, and timelines for follow up. Results from the LDCT scan and Lung Health Check were subsequently sent by letter. Perceptions of this booklet were assessed among participants with indeterminate pulmonary findings when they attended a face-to-face appointment immediately before their three-month interval scan. Specifically, questions assessed the perceived usefulness of the booklet and the amount of information contained in it.70.1% (n = 1,412/2,014) participants remembered receiving the booklet at their appointment. Of these participants, 72.0% (n = 1,017/1,412) found it quite or very useful and 68.0% (n = 960/1,412) reported that it contained the right amount of information. Older participants, those from the least deprived socioeconomic quintile and those of Black ethnicity were less likely to report finding the booklet either quite or very useful, or that it contained the right amount of information. Participants who remembered receiving the booklet were more likely to be satisfied with the process of results communication by letter.Providing written information that prepares participants for possible LDCT results and their significance appears to be a useful resource and a helpful adjunct to a written method of results communication for large scale LCS programmes.

Lung cancer screening (LCS) eligibility is largely determined by tobacco consumption. Primary care smoking data could guide LCS invitation and eligibility assessment. We present observational data from the SUMMIT Study, where individual self-reported smoking status was concordant with primary care records in 75.3%. However, 10.3% demonstrated inconsistencies between historic and most recent smoking status documentation. Quantified tobacco consumption was frequently missing, precluding direct LCS eligibility assessment. Primary care recorded "ever-smoker" status, encompassing both recent and historic documentation, can be used to target LCS invitation. Identifying those with missing or erroneous "never-smoker" smoking status is crucial for equitable invitation to LCS.

INTRODUCTION: Low-dose CT (LDCT) screening reduces lung cancer specific mortality. Several countries, including the UK, are evaluating the clinical impact and cost-effectiveness of LDCT screening using the latest evidence. In this paper we report baseline screening performance from five UK-based lung cancer screening programmes.METHODS: Data was collected at baseline from each screening programme. Measures of performance included prevalence of screen detected lung cancer, rate of surveillance imaging for indeterminate findings and surgical resection rates. Screening related harms were assessed by measuring false positive rates, number of invasive tests with associated complications in individuals without lung cancer and benign surgical resection rates.RESULTS: A total of 11,148 individuals had a baseline LDCT scan during the period of analysis (2011 to 2020). Overall, 84.7% (n = 9,440) of baseline LDCT scans were categorised as negative, 11.1% (n = 1,239) as indeterminate and 4.2% (n = 469) as positive. The prevalence of screen detected lung cancer was 2.2%, ranging between 1.8% and 4.4% for individual programmes. The surgical resection rate was 66% (range 46% to 83%) and post-surgical 90-day mortality for those with lung cancer 1.2% (n = 2/165). The false positive rate was 2% (n = 219/10,898) and of those with a positive result, one in two had lung cancer diagnosed (53.3%). An invasive test was required in 0.6% (n = 61/10,898) of screening attendees without lung cancer; there were no associated major complications or deaths. The benign surgical resection rate was 4.6% (n = 8/173), equating to 0.07% of the screened population.DISCUSSION: The performance of UK-based lung cancer screening programmes, delivered within or aligned to the National Health Service, compares favourably to published clinical trial data. Reported harms, including false positive and benign surgical resection rates are low. Ongoing monitoring of screening performance is vital to ensure standards are maintained and harms minimised.

Background: CHEST guidelines on lung cancer screening during the COVID-19 pandemic1 support delaying interval scans for 3-6 months. There is a concern that progression during this time could result in a higher stage at diagnosis. To determine the safety of this approach, we investigated whether time to interval scan was associated with disease stage at diagnosis. Method: The SUMMIT Study aims to assess the implementation of low-dose CT for lung cancer screening in a high-risk population and to validate a multi-cancer early detection blood test. Indeterminate nodules are followed up at 3 months. Participants with interval scans delayed to ≥4 months due to the pandemic and a comparison pre-pandemic group with scans performed at the target timeframe of 3-4 months were identified. Outcomes from cases referred for definitive assessment following interval scan were analysed. Results: Conclusion: Preliminary data does not suggest a shift to higher stage at diagnosis from delayed interval scans performed at 4-6 months. Whilst this must be validated with additional cases, if confirmed this evidence supports the safety of the CHEST guidelines for lung cancer screening during the COVID pandemic. 1. Management of Lung Nodules and Lung Cancer Screening During the COVID-19 Pandemic CHEST 2020

Introduction: Squamous cell lung cancers are known to arose from preinvasive lesions typically found in the central airways. Smoking exposure results in morphological progression from normal epithelium to dysplasia, carcinoma in situ (CIS) and invasive carcinoma. The treatment of high grade preinvasive lesions (HGL) remains controversial and although radical therapies are advocated there is no randomised evidence to support this practice. Methods: An international multicentre phase II/III randomised controlled trial will test whether photodynamic therapy (PDT) of HGLs will reduce the incidence of progression to invasice cancer when compared to surveillance alone. Data on smoking status and co-morbidities will be collected and individuals randomised to receive either 6-12 monthly surveillance with AFB and CT chest or PDT (using chlorine e-6, 665nm) followed by surveillance with autofluorescence bronchoscopy and CT chest. Results: The primary outcome is the proportion of HGLs that develop into invasive lung cancers over 3 years. Secondary outcomes are the incidence of multifocal lung cancer, overall and lung cancer specific survival, health related quality of life, and cost effectiveness. Biopsies will also be collected to create a unique preinvasive tissue bank. This will enable identification of epi-genetic signatures which will underpin models of developing invasive lung cancer. Conclusions: PDT combines tumour specificity, repeatability and patient acceptability. The PEAR Trial, funded by CRUK, is the first phase III randomised trial of an endobronchial therapy for the prevention of lung cancer and is scheduled to open in 4 sites across England and the Netherlands in April 2017.

Introduction Rapid and early diagnosis is are important factors in determining outcomes in lung cancer. The aim of this study was to investigate the impact of immediate reporting of chest X-rays from primary care by reporting radiographers on the time to diagnosis of lung cancer. Methods A 12 month, block randomised trial was conducted at a single centre in London, UK. Half of the sessions per week (5) were randomised to an immediate or routine chest X-ray (CXR) report by a reporting radiographer, with an immediate CT where indicated. Time taken to diagnosis of lung cancer or discharge from the lung cancer pathway was determined and Mann-Whitney test used. Results During this study 8,732 patients were recruited and a total of 9,137 CXRs were performed with 4,128 (45.1%) CXRs in the immediate radiographer reporting arm. A total of 49 lung cancers were diagnosed, 26 in the immediate arm. Time to diagnosis of lung cancer for patients in the immediate arm was a median of 21.5 days (mean 26.0) compared with 30 days (mean 41.6) in the routine CXR arm (p=0.012). For patients with a suspicious CXR, diagnosis of lung cancer was achieved in a median of 18 days (mean 24.3) compared with 32 days (mean 42.6) in the routine arm (p=0.0375). Conclusion At a single centre, immediate reporting of CXRs referred from primary care by radiographers reduced time to diagnosis of lung cancer by a median of 14 days where the CXR was suspicious and by a median of 8.5 days for all patients. This has significant implications for patient outcome and adherence to new cancer targets.

Background Surgery is the treatment of choice for early stage non-small cell lung cancer (NSCLC). However, curative intent is commonly not achieved due to inaccurate clinical staging and disease recurrence. Aim We aimed to determine the incidence of futile thoracotomies (FT) in patients with NSCLC following surgery with curative intent. In addition, we wished to identify prognostic factors that predicted FT. Methods In this analytical retrospective cohort study, thoracotomy cases between October 2003 and September 2008 at a single institution were identified. Confirmed cases of primary NSCLC only were included. A thoracotomy was deemed futile if any one of the following criteria were met: pathologically confirmed N2, N3, or M1 disease, an exploratory thoracotomy, or a thoracotomy in a patient who developed recurrent disease or died within 1 year of surgery. When a PET scan was performed, the SUVmax of the primary tumour was reported by a radiologist blinded to the clinical information. Case notes and hospital systems were interrogated for evidence of recurrence and survival. Statistical analysis was performed with STATA version 10 for Windows. Results We identified 171 consecutive patients with NSCLC who underwent lung resection with curative intent. 105 (61%) were male and mean age at the time of surgery was 66 years. 134 (78%) had lobectomy, 8 bi-lobectomy, 19 pneumonectomy and 10 sub-lobar resection (segmentectomy or wedge resection). Overall 46 (27%) underwent FT. Nine patients (5.2%) had clinically unsuspected N2 disease at pathological staging. An SUVmax of the primary tumour greater than 8 was associated with an increased risk of FT (RR 2.35 (p=0.03)) (Abstract P222 Table 1). The presence of lymphovascular invasion was also associated with a increased risk of FT (RR 1.71 (p=0.04)). Those with a primary tumour greater than or equal to 3 cm in size had a RR of 1.91 (p=0.02) of FT. Conclusions Between 2003 and 2008, 27% of patients at our cardiothoracic centre for lung cancer underwent a futile thoracotomy. High SUVmax, the presence of lymphovascular invasion and tumour size ≥3 cm are predictors of FT. Future, prospective studies employing adjuvant chemotherapy in these patient groups are warranted.