What is being done to improve earlier detection of lung cancer?

Earlier detection of lung cancer offers a critical opportunity to reduce deaths and improve quality of life and outcomes from the disease. Screening high-risk individuals via low-dose computed tomography (LDCT) is a safe and effective way to achieve this, but rapid implementation of screening is not always feasible. LDCT should therefore be part of a comprehensive national strategy for earlier detection, much of which can be implemented at lower cost and in the shorter term.

There are many challenges to detecting lung cancer earlier, whether or not screening programmes are in place, including low awareness and health system capacity. These challenges can be met with well-evidenced approaches, coupled with further research, that are being adopted around the world to realise the goal of detecting lung cancer earlier.
 

Achieving a stage shift to earlier detection

Detecting lung cancer at an early stage (stage I or II) can often mean there are more available treatment options for the person receiving a diagnosis. In some circumstances, this may even include curative treatments.

The five-year survival rate of lung cancer diagnosed at stage I can be over 70%, compared with just 10% when diagnosed at a later stage. But most of the time, lung cancer is detected at stage III or IV, which contributes to its being the leading cause of cancer-related deaths.

The most effective way to screen for lung cancer is via low-dose computed tomography (LDCT). This is a safe and effective tool to screen high-risk individuals and can reduce mortality by up to 25%. Alongside a growing number of commitments to implement national screening programmes, it is essential to acknowledge that LDCT screening can sit as part of a broader suite of tools for earlier detection of lung cancer. In some locations, at least in the short term, LDCT screening may not yet be feasible, but other tools could readily be adopted to address some of the key challenges in earlier detection.
 

Low public awareness means many people do not access health services

At earlier stages of lung cancer, symptoms may be minimal and/or similar to other respiratory conditions, hindering a timely diagnosis. It is important that healthcare professionals and the wider public have access to information about lung cancer, the risks associated with the disease, and services such as screening. This information must be delivered in appropriate formats and forums.

Research from Malaysia has found generally low levels of public awareness of lung cancer and healthcare services for the disease, and this may prevent people from seeking healthcare or taking up invitations for screening services where they exist.

A multi-sectoral approach to has been developed improve public awareness, bringing together advocacy organisations, healthcare professionals and researchers. For example, the Lung Cancer Network Malaysia’s ‘Hope for Survival’ campaign provides free educational resources that can be shared via social media to improve understanding of the disease, with the aim of encouraging people to seek screening services.

In the US, the third National Lung Cancer Screening Day will take place this year. It aims to raise awareness of lung cancer screening and encourage people who are eligible for screening to participate on the day. It also aims to reduce disparities in access to screening by providing additional flexibility for when people can obtain a scan, as it takes place on a Saturday so most participants do not need to take time of work.
 

Early detection activities can be more than the sum of their parts

For early detection strategies to be most effective, specific approaches should be designed and adopted to complement one another, and can be implemented in tandem or in a phased approach. This could help ensure that specific tools are more effective (e.g. by combining LDCT screening with smoking cessation services) and that more people are able to benefit from services that enable earlier detection.

In Brazil, the Propulmão project takes a multifaceted approach to increasing the earlier detection of lung cancer in Bahia. While the programme incorporates LDCT screening, it also includes educational and professional training for healthcare professionals, public health initiatives (i.e. smoking cessation) and research.

This approach is showing clear positive trends towards achieving the earlier detection of lung cancer. It is also helping to bring discussions of earlier detection and LDCT screening to the attention of policymakers in Brazil.

We explored the screening component of ProPulmao’s work in more detail in our recent case study.
 

Research is needed to underpin policy commitments to prioritise earlier detection

When considering which earlier detection strategies to implement, and how, it is vital to validate these strategies through research of their effectiveness and feasibility. This is a critical component of policy decision-making.

In Scotland, the RADICAL study will explore the use of AI processing of chest X-rays to reduce reporting time for suspicious lung nodules. The study will look to assess whether this process reduces potential findings of lung cancer being missed, and whether it reduces the time for people to be referred for onward investigation where it is required as assessed by a radiologist. It will also include an economic evaluation and investigate the acceptability of the process to service users and healthcare providers. This will provide further evidence on how AI can expedite pathways for more lung cancer can be detected this way, while minimising any additional capacity needs for health systems.

An upcoming report from the Lung Cancer Policy Network will explore the opportunity that optimising the management of incidental pulmonary nodules can play in achieving the earlier detection of lung cancer.

The Lung Cancer Policy Network advocates for the implementation of approaches that improve the earlier detection of lung cancer. Explore the research and our policy recommendations in our report, Increasing the earlier detection of lung cancer: a toolbox for change.