On 26 June, the Secretary of State for Health and Social Care, Steve Barclay, announced the rollout of a new targeted lung cancer screening programme in England.
The announcement follows the UK National Screening Committee’s (UK NSC) September 2022 recommendation that all UK nations move towards implementing lung cancer screening with an integrated smoking cessation service. In England, the successful pilots of targeted lung health checks (TLHCs) are already making a huge difference in catching more cases of lung cancer early, when treatment is more likely to be successful.
England’s plan is to achieve 100% coverage by March 2030, but the other UK nations still need to get started. Governments and devolved administrations in Wales, Scotland and Northern Ireland must make a ministerial commitment to rolling out a national targeted lung cancer screening programme to ensure everyone who needs it can benefit from lung screening, no matter where they live.
What is lung cancer screening?
Cancer screening programmes help reduce deaths from cancers by diagnosing them early or preventing them from developing in the first place. Lung cancer screening is specifically targeted at those most at risk of developing lung cancer: people aged between 55 and 74 who either smoke or used to smoke.
Lung screening involves having an assessment with a health professional to find out about your lung cancer risk. If this shows that you are at higher risk of lung cancer, you will be invited to have a low-dose CT scan to take a detailed picture of the lungs.
Why does lung cancer screening matter?
In the UK, lung cancer takes more lives than any other type of cancer. There have been big improvements in how we treat other forms of the disease, but long-term lung cancer survival isn’t much higher than it was 50 years ago.
Targeted lung cancer screening is a chance to change that. It means more people can be diagnosed at an early stage, when treatment is more likely to be successful.
Evidence from trials has shown that screening people at high risk of lung cancer can save lives from the disease. In the first phase of the TLHC scheme in England, more than 2,000 people were detected as having lung cancer. 76% of those lung cancers were caught in their earlier stages, compared to 29% of the lung cancers detected outside of the programme.
That improvement points to how targeted lung screening can help tackle cancer-related inequalities. When it comes to cancer cases, the starkest differences between the most and least deprived areas of the UK are in smoking-related cancers like lung cancer. Rates of smoking-related cancers are 2 times higher for the most deprived populations compared to the least deprived.
It’s also important to remember that, though we don’t see clouds of smoke in train stations and restaurants anymore, smoking is still the biggest cause of cancer across the country. And there’s a big difference in smoking rates between people in the most and least deprived groups. In Northern Ireland, almost 3 in 10 adults in the most deprived groups smoked in 2019/20, compared with 1 in 10 people in the least deprived groups. That’s mirrored in other parts of the UK too.
So, it’s clear that if we’re serious about tackling health inequalities in cancer outcomes, we need to make significant advances against lung cancer. Screening can play a vital role here, but it needs to be accessible to people at higher risk of smoking-related harm, including people from more deprived areas, the LGBTQ+ community, people with mental health conditions and those experiencing homelessness.
To make that possible, the health services in all four nations should look to improve primary care data collection on smoking to inform who should be invited for screening. Scotland, Wales and Northern Ireland should also build on insights from TLHCs in England to develop their own lung screening programmes.
It’s also vital that people invited for lung cancer screening are given support to help them stop smoking. To start, screening staff need to be trained to effectively deliver stop-smoking interventions during screening appointments. Then there also needs to be adequate funding for stop-smoking services so that people continue to receive support over the following weeks and months.
What is happening in Scotland, Wales and Northern Ireland?
Lung cancer is the most common cancer in Scotland – and it’s more than twice as common in the most deprived areas as it is in the least deprived areas of the country. While there have been small pilot studies of lung health checks, these have been limited in scope. The Cancer Strategy for Scotland committed to improving cancer survival by 2033, particularly among the currently less-survivable cancers such as lung cancer. To achieve this ambition the Scottish Government must commit to, and fund, a national screening programme.
NHS Wales identified diagnosing cancer as early as possible as a key ambition of its Cancer Improvement Plan. Here, too, a targeted lung cancer screening programme is crucial to making that a reality. NHS Wales agreed to a lung health check pilot within Cwm Taf Morgannwg University Health Board to inform how Wales can best implement targeted lung cancer screening. But the pilot is only kicking off at this year and will not be completed until 2024/25. Evidence from England shows Wales can move further and faster on lung cancer. We now need to see a ministerial commitment to a nationwide roll out of lung screening in Wales.
In Northern Ireland, ongoing political instability has meant there has been no Executive and Assembly to drive forward a decision on targeted lung cancer screening. The Northern Ireland Cancer Strategy included an action to implement all UK NSC recommendations, including lung screening, and that needs to happen as soon as the political situation allows. Prioritising the rollout of targeted lung screening will ensure more of the over 1,300 people diagnosed with lung cancer in Northern Ireland every year can live beyond cancer.
What should happen now?
Governments and administrations in devolved nations must take immediate action to screen the people most at risk of lung cancer. Helpfully, they can use the example of England’s TLHC programme to plan and launch their schemes as quickly and effectively as possible.
As part of that, devolved governments and administrations must ensure that enough equipment and staff are in place to see a patient through diagnosis and possible treatment. Across the whole of the UK, stop smoking support also needs to be embedded within, and available following, lung screening.
Lung cancer takes more lives than any other type. Targeted lung cancer screening is a way to diagnose it earlier and give people the best chance of surviving it. Inaction by devolved governments risks people living in Wales, Scotland and Northern Ireland being left behind.
Alice Hilborn is a policy advisor at Cancer Research UK