Invitation and Lung Health Check

Invitation and Lung Health Check (LHC)

Participants invited for an LHC are those who:

are, at the date of the first low dose CT scan, aged between 55 and 74 years, 364 days of age
are registered with a GP practice
have ever smoked (defined as 100 cigarettes in participants lifetime).

During the LHC, participants will have a discussion to assess the participant’s individual lung cancer risk. This will include questions about smoking habits. Current smokers will be offered smoking cessation advice, formal smoking cessation service referral on an opt-out basis.

Individuals will be assessed for eligibility criteria by confirming medical, social and employment history and risk factors for lung cancer. Validated lung cancer risk assessment tools will be used to quantify risk. The prostate lung colorectal and ovarian (PLCO)M2012 risk prediction model and the Liverpool lung project (LLP) version 2 [2, 3] to select participants to be offered an LDCT. The American PLCOM2012 model has been adapted for use in the UK to reflect UK ethnic groups.

Evidence suggests that a risk threshold of ≥1.51% risk of lung cancer over six years is the minimum threshold for PLCOM2012, and ≥2.00% risk of lung cancer over five years for LLPv2 [4, 5]. However, the latter has only been shown in modelling studies and may lead to substantially more LDCTs. Thus, a risk threshold for LLP of ≥2.5% is considered the minimum threshold

Eligibility for Low Dose CT Scan

For the purposes of the Lung Cancer Screening programme, participants satisfying either LLPv2 or PLCOM2012 are to be considered eligible for a low-dose CT provided they meet the inclusion criteria and do not have any of the exclusion criteria

Inclusion criteria:

• Age is from 55 years to 74 years and 364 days.

• Willing and able to undergo LDCT.

• PLCOM2012 risk of ≥1.51% over six years or LLPver2 five-year risk of ≥2.5%.

Exclusion criteria:

Weight or physical size exceeds restrictions for scanner (e.g. >200kg).
Participant unable to lie flat.
Poor physical fitness such that treatment with curative intent would be contraindicated. This may require a second opinion or advice from the local lung cancer MDT. This may include:
Participants registered on the palliative care register
Participants with severe frailty (electronic frailty index >0.36)
Participants with metastatic cancer but not metastatic prostate cancer, metastatic breast cancer or metastatic melanoma (unless participants are already receiving annual diagnostic chest CT scans).
Participants with mesothelioma
Participants currently under active treatment for lung cancer or under surveillance for lung cancer following treatment

Consent for CT screening is taken by a suitably trained clinician or non- clinician, familiar with the risks and benefits of the process and radiation exposure.

Low Dose CT Chest Scan

The scan will typically show one of three things:

No significant findings or nodules with a volume of <80mm3 or 5mm in maximum diameter
Indeterminate results
Something that requires further investigation

If the individual presents with clinical features of lung cancer or any of the following symptoms they should proceed directly to a Low Dose CT Chest scan (LDCT)

• persistent haemoptysis

LDCT suspicious for lung cancer will receive a screening referral into the suspected lung cancer rapid assessment and diagnosis pathway.

Minor incidental findings are common on LDCT Incidental findings will be reviewed by the Screening Review Meeting (SRM) and clear recommendations will be made to the relevant clinicians and to the participant.

When will Lung Cancer Screening be in my area?

The Lung Cancer Screening Programme has formulated a risk stratified approach to the roll out plan of Lung Health Checks in your area. This approach has been reviewed and agreed by Place and GP Lead Representatives. Practices will be contacted by their local Place/ICB to get ready for sending eligible patient demographics (aged 55-74years and ever smoked) to the Lung Cancer Screening team. This process happens around 3-4 months before your patients start to be invited for screening. The Lung Cancer Screening team will then coordinate sending of patients invites.

Copies of the role out plan can be provided on request. Please contact your place leads or the Lung Cancer Screening team.