Background information

Lung cancer is frequently diagnosed at a later stage than other cancers, due to there often being no symptoms at an early stage.

What happens at a lung health check?

1. A nurse asks the participants questions about their breathing, lifestyle, family and medical history. Height and weight measurements are also recorded.
2. Based on the answers provided by the participant, those identified as being above a certain level of future lung cancer risk (based on one or both of two different risk assessment models) will be invited to have a low dose CT scan. This may take place on the same day, or at a later. Participants who are not invited for a low dose CT scan will be discharged from the programme.
3. If the results of the low dose CT scan show signs of anything concerning, the participant may be referred for further low dose CT scans and treatment.

England

The Targeted Lung Health Check (TLHC) programme is currently established across 23 locations in England with some of the highest rates of mortality from lung cancer and offers lung health checks to participants aged 55 to 74 who are current or former smokers. The programme aims to improve earlier diagnosis of lung cancer, at a stage when it is much more treatable – ultimately saving more lives. It is estimated that these initial projects will diagnose around 6,000 cancers at an earlier stage than they would otherwise have been.

NHS England sets out the protocols in place for the programme. You can find them here.

Wales
Following a scoping report in 2020, the Wales Cancer Network provided recommendations to the Cancer Implementation group which included implementing a small-scale pilot in Wales. This has been agreed in principle and planning is progressing with the aim of commencing this towards the end of 2022.
Updated information from NHS Wales can be found here.

Currently, there are no lung health checks taking place in Scotland, or Northern Ireland.

Benefits and harms of lung screening

These projects are an important opportunity to learn more about how a targeted lung screening programme could be implemented in the NHS, should the decision be made to scale it up to a national programme. It is crucial that these projects are delivered
to a high standard and evaluated robustly. These projects also offer a valuable and specific research opportunity to address some outstanding questions about lung screening.

Lung health checks pilot projects have promising results suggesting the programme saves lives. According to Cancer Research UK, if 1000 people have three low dose CT scans, then 3 lives could be saved, 4 could be diagnosed with a cancer that wouldn’t
have caused any harm (overdiagnosis), and 13 people who don’t have cancer could have an invasive test (i.e. biopsy).

However, there are harms associated with screening, because:

• Screening does not always identify cancer, so some may still be missed
• There may be false-positive results meaning a need for scans or a biopsy, which might worry the patient
• Screening may detect cancers that won’t ever cause problems, leading to treatment which might be unnecessary
• If a patient has a CT scan, they are exposed to small amounts of radiation.

Additional resources

Link: Lung Health Checks, Cancer Research UK (2021)
Link: Lung cancer screening, Cancer Research UK (2020)
Link: Targeted screening for Lung Cancer with Low Radiation Dose Computed Tomography, NHS England (2022)
Link: Lung Health Check, NHS Wales Health Collaborative (2022)
Link: Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial, The New England Journal of Medicine Vol 382:6 (2020)