CT scanners like this one are used for lung cancer screening.
A targeted lung screening programme is the step-change in care that the NHS needs to catch lung cancer early. So, when the UK National Screening Committee gave the recommendation for it to go ahead, I was thrilled. It’s something that so many of us in the lung cancer research community have been working towards for years.
That said, with cash-strapped governments across the UK prioritising ‘value for money’ and efficiency, this might not seem like the most hospitable environment in which to recommend rolling out a new screening programme.
But the return on investment from lung screening could be massive. Lung cancer is the third most common cancer type in the UK, causing 34,800 deaths every year, more than any other cancer. There is huge potential here not just for saving and improving lives, but also for using money more cost-effectively. That’s because it’s much easier to treat lung cancer when it’s diagnosed early.
Lung cancer also disproportionately affects people experiencing deprivation. There are around 30,000 extra cancer cases each year in the UK due to deprivation, and lung cancer is the biggest contributor to these excess cases. It’s only right that we find ways to detect this disease as early as we can to save lives, and we must do so in a way that benefits everyone equally.
The truth is, when diagnosed at its earliest stage, 88% of people with lung cancer will survive their disease for one year or more, compared with 19% when the disease is diagnosed at the latest stage.
But people will understandably have questions. The public may be wondering why the screening programme will only be offered to people at higher risk of lung cancer. Or why it has taken so long for a screening programme to be recommended for a disease which affects so many.
Accumulating the right evidence has taken time – we had to make sure the benefits and harms are well understood. As for why only those at high risk are invited, well, while not every case of lung cancer is caused by tobacco inhalation, 7 in 10 are, meaning those with a smoking history are most likely to benefit from screening.
In those cases, it’s important to remember that smoking is in fact an addiction. Most people who smoke started when they were children and take an average of 30 attempts to successfully stop.
What’s more, tobacco companies have engineered their products to be as addictive as possible, and they have historically targeted specific groups with their marketing.
Some people are more likely to start smoking due to the environment they live in. For example, if your parents smoke, then you are more likely to smoke too. Some people also find it more difficult to stop than others despite trying just as many times. This is because the world around them hampers their attempts to quit. That could be because of lack of access to cessation services, difficult life circumstances, financial strain and knowing other people who smoke, to name just a few factors.
For a long time, lung cancer has been considered a death sentence because it is too often diagnosed late. Many people have seen loved ones experience late diagnoses, and this can act as a barrier to seeking help or lead people to think that screening wouldn’t benefit them. Sadly, those most at risk of lung cancer are also the least likely to attend screening appointments. My research has shown that worrying about being diagnosed with lung cancer, being blamed for getting it and thinking treatment won’t work are all things that can put people off. If you’re convinced there is nothing a doctor could do, why go for screening?
The truth is, when diagnosed at its earliest stage, 88% of people with lung cancer will survive their disease for one year or more, compared with 19% when the disease is diagnosed at the latest stage. Experiencing positive cancer outcomes can make people more willing to consider that screening invite when it comes over the phone or through the letterbox. We need this message of improved lung cancer outcomes and treatment to permeate its way into public consciousness.
We need to ensure that local stop smoking services, which give people who smoke the best chances of quitting, are available, well-funded and ready to go hand in hand with the screening rollout.
But this isn’t about forcing our loved ones into an appointment they don’t want to go to. It’s all about personal informed choice – screening is not right for everyone. My work has been about finding a way to support people’s decision-making and communicate the benefits of screening, as well as the harms. This means when they make their decision to attend or not, it’s not because they feel pressured, but because they’ve been empowered by knowledge.
It’s important, however, to remember that lung cancer can’t be solved purely by a screening programme. Improving awareness of lung cancer symptoms across the entire population is fundamental to making sure people seek help quickly from their GP when necessary, whether or not they have been screened.
It’s also vital to make sure that cessation services are available across all UK nations, which isn’t currently the case. Having specialists on hand to offer people guidance about quitting following screening appointments is a vital first step. But, if there aren’t cessation services in place to help with everything that comes after that, it’s much harder for people to stop smoking. We need to ensure that local stop smoking services, which give people who smoke the best chances of quitting, are available, well-funded and ready to go hand in hand with the screening rollout.
It’s taken a long time to get the right evidence for screening, with hard work and dedication from so many people, and no doubt there is further to go. Now, it’s in the hands of the health service, local public health provision, and the governments that fund them. Each individual UK nation needs to implement screening in a way that will be equitable as well as effective.
That means getting clarity on primary care data to ensure invitations reach the right people, using strategies that help everyone equally to consider and attend screening (if they choose to), funding stop smoking services and guaranteeing expert leadership so we can assure those who are invited that they will receive the highest quality care possible.
We know that cancer is a progressive disease. This means that the quicker you find it, the more likely that treatment will be successful, and this is certainly true of lung cancer.
In the current economic climate, each UK government will be keen to make good investments. As far as I can tell, spending money on a screening programme that could save countless lives and reduce the gap between the UK’s most and least deprived communities is an opportunity to make a huge difference.
Dr Samantha Quaife is a Cancer Research UK-funded research fellow at Queen Mary University of London. She uses behavioural science to make lung cancer screening more equitable, accessible and impactful.