Smokers’ interest in a national lung cancer screening programme

By Samantha Quaife and Maria Kazazis

Lung cancer is typically diagnosed too late; a major reason why it remains the leading cause of cancer death both in the UK and globally. Catching lung cancer early drastically improves survival, but often there are no symptoms in the early stages, or at least no symptoms that initially cause alarm.

Therefore, a national lung cancer screening programme is being considered in the UK. This would use a special type of CT scan with a lower dose of radiation (a LDCT scan) to screen for nodules in the lungs which could be early cancers. There is evidence from a large US trial that this decreases deaths from lung cancer among current smokers and former smokers aged 55-74 who have a significant smoking history. However, there are risks as well as benefits to screening and the UK are waiting for further European evidence.

One potential problem our research is trying to address is low uptake. For screening to work best, those taking part should be at high risk of developing lung cancer (usually due to a long history of tobacco smoking among other factors). Smoking is more common within socioeconomically deprived communities meaning that a greater proportion of adults are at high risk when compared with more affluent communities. However, in both Europe and the US, fewer smokers and individuals of a lower socioeconomic position, have taken part in screening when offered by research trials. But trial participation is different. What we don’t know is to what extent this problem might exist in the context of a national NHS programme.

In our newly published paper, funded by Cancer Research UK and the Medical Research Council, we surveyed 1464 adults aged 50-70 years as part of our Attitudes Behaviour and Cancer-UK Survey (ABACUS). We asked participants how likely they were to take part in screening following three hypothetical screening invitation scenarios. We also asked participants how much they worried about lung cancer, whether they thought the chances of surviving early stage lung cancer were good and whether they thought (again hypothetically) they would have surgery if screening found an early stage cancer. We compared current smokers with non-smokers on all these beliefs.

Most participants (97%) thought screening was a good idea and intended to be screened, regardless of their smoking status (>89% of current and former smokers). This is encouraging in principle, but intentions are not always the most accurate way of predicting actual screening behaviour. Indeed, we also found that smokers reported worrying more about lung cancer, and were less likely to think the chances of surviving lung cancer (when detected early) are good, or think they would opt for surgery (the most effective treatment for early stage lung cancer). It’s possible that these negative perceptions may deter smokers from screening. Importantly though, beliefs are modifiable. To optimise participation among those at high risk, we should communicate the screening offer in a way that minimises excessive worry, clearly explains the improvement in survival for early disease and dispels any misconceptions about surgical treatment.

Reference: Quaife, S. L., Vrinten, C., Ruparel, M., Janes, S. M., Beeken, R. J., Waller, J., McEwen, A. (2018). Smokers’ interest in a lung cancer screening programme: a national survey in England. https://doi.org/10.1186/s12885-018-4430-6