Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester, Manchester, UK.
Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK.
Thorax. 2023 Dec 15;79(1):58-67. doi: 10.1136/thorax-2023-220001.
Although lung cancer screening is being implemented in the UK, there is uncertainty about the optimal invitation strategy. Here, we report participation in a community screening programme following a population-based invitation approach, examine factors associated with participation, and compare outcomes with hypothetical targeted invitations.
Letters were sent to all individuals (age 55-80) registered with a general practice (n=35 practices) in North and East Manchester, inviting ever-smokers to attend a Lung Health Check (LHC). Attendees at higher risk (PLCO score≥1.5%) were offered two rounds of annual low-dose CT screening. Primary care recorded smoking codes (live and historical) were used to model hypothetical targeted invitation approaches for comparison.
Letters were sent to 35 899 individuals, 71% from the most socioeconomically deprived quintile. Estimated response rate in ever-smokers was 49%; a lower response rate was associated with younger age, male sex, and primary care recorded current smoking status (OR 0.55 (95% CI 0.52 to 0.58), p<0.001). 83% of eligible respondents attended an LHC (n=8887/10 708). 51% were eligible for screening (n=4540/8887) of whom 98% had a baseline scan (n=4468/4540). Screening adherence was 83% (n=3488/4199) and lung cancer detection 3.2% (n=144) over 2 rounds. Modelled targeted approaches required 32%-48% fewer invitations, identified 94.6%-99.3% individuals eligible for screening, and included 97.1%-98.6% of screen-detected lung cancers.
Using a population-based invitation strategy, in an area of high socioeconomic deprivation, is effective and may increase screening accessibility. Due to limitations in primary care records, targeted approaches should incorporate historical smoking codes and individuals with absent smoking records.
尽管肺癌筛查正在英国实施，但对于最佳邀请策略仍存在不确定性。在这里，我们报告了在基于人群的邀请方式下参与社区筛查计划的情况，研究了与参与相关的因素，并将结果与假设的靶向邀请进行了比较。
向曼彻斯特北部和东部所有注册全科医生的个体（年龄 55-80 岁；n=35 家诊所）发送信函，邀请所有吸烟者参加肺健康检查（LHC）。高危人群（PLCO 评分≥1.5%）可接受两轮年度低剂量 CT 筛查。初级保健记录的吸烟代码（现吸烟和既往吸烟）用于模拟假设的靶向邀请方法进行比较。
共向 35899 人发送了信函，其中 71%来自最贫困的五分位数。曾吸烟者的估计回复率为 49%；较低的回复率与年龄较小、男性和初级保健记录的当前吸烟状态有关（OR 0.55（95%CI 0.52 至 0.58），p<0.001）。符合条件的应答者中 83%（n=8887/10708）参加了 LHC。51%（n=4540/8887）符合筛查条件，其中 98%（n=4468/4540）进行了基线扫描。筛查依从性为 83%（n=3488/4199），两轮筛查共检出 3.2%（n=144）的肺癌。经模型化的靶向方法需要的邀请数量减少了 32%-48%，识别出了 94.6%-99.3%的符合筛查条件的个体，并纳入了 97.1%-98.6%的筛查发现的肺癌。
在高社会经济贫困地区，使用基于人群的邀请策略是有效的，可以提高筛查的可及性。由于初级保健记录的限制，靶向方法应纳入既往吸烟记录和无吸烟记录的个体。
