CT scan catches 70% of lung cancers at early stage — SUMMIT study

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Giving smokers and ex-smokers a CT scan uncovers cancerous lung tumours when they are at an early enough stage so they can still be removed, found initial results from the UK's SUMMIT study, due to be published later this year.

The Guardian reports that the National Health Service (NHS) study that  three out of four lung cancer cases are diagnosed at stage three or four, when it is already too late to give the person potentially life-saving treatment. However, the SUMMIT study, being run by specialists in the disease at University College London Hospital NHS trust, offers real hope that lung cancer can become a condition that is detected early.

CT scanning meant that 70% of the growths detected in people’s lungs were identified when the disease was at stage one or two – a huge increase in the usual rate of early diagnosis.

“It’s really a major breakthrough for lung cancer,” Dr Sam Janes of UCLH, the senior investigator of the trial, is quoted in the report as saying. Lung cancer has never had anything that enabled us to detect this devastating cancer earlier and offer curative treatment to this number of lung cancer patients.”

“It’s important to highlight how effective CT scanning is. In my lung cancer clinic at UCLH, seven out of 10 people have cancer that’s been inoperable, incurable, from the first time they saw a doctor. Whereas with the cancers that we see with Summit, seven out of 10 are potentially curable, because they were detected earlier.

“We have many, many patients who can’t believe their luck that they’ve taken part because they’ve had their scan, they’ve had a nodule – an early cancer – detected, and then they’ve had surgery. People get out of hospital within three to five days and can get back to work or their usual routine within six weeks. That’s stopped them from presenting to a doctor maybe 18 months later with a cancer that has spread and is often incurable.”

According to the report, Janes and his team found 180 cases of lung cancer among 12,100 smokers and ex-smokers aged 55-78 in north central and north-east London, many of whom were from poorer backgrounds. They volunteered to undergo what he called a “lung health MOT” when they received an invitation letter from their GP. Of those, 70% were uncovered when they were still at stage one or two.

Experts say the findings show that the government should move to bring in routine screening of smokers and ex-smokers in order to cut the horrendous death toll from the disease.

“Now that CT screening for lung cancer has been shown to work, we very much hope that a lung cancer screening programme will be introduced in England”, said Dr Robert Rintoul, the chair of the clinical advisory group of the UK Lung Cancer Coalition, a group of leading experts in the disease and patient charities.

“The Summit study will teach us more about how to successfully implement CT screening in a high-risk population”, Rintoul said.

Previous studies in the US and Europe have also shown that CT scanning can find lung cancers that would otherwise have remained hidden.

Details of the SUMMIT study, which started two years ago:

The SUMMIT Study, which will begin in early 2019, has two aims: to detect lung cancer early amongst at-risk Londoners when the chance of successful treatment and survival from Britain’s biggest cancer killer is greatest; and to support the development of a new blood test for the early detection of multiple cancer types, including lung cancer.

In addition, the study will provide evidence to inform a potential national lung cancer screening programme. Currently in England, people are offered screening for breast, bowel and cervical cancer, but not lung cancer.

“Lung cancer is the biggest cancer killer in the UK because most people only experience symptoms when the cancer is at an advanced stage when it is very difficult to treat,” said Professor Sam Janes (UCL Medicine and UCLH), chief investigator of the SUMMIT Study, said.

“This large-scale study gives us a unique opportunity to detect lung cancer much earlier when treatment is more likely to be successful amongst those proven to be most at risk – people who smoke or used to smoke, aged between 50 and 77,” he said.

The study is a key work programme of the UCLH Cancer Collaborative, which brings together healthcare organisations across north and east London, to improve early cancer diagnosis, outcomes and care for patients.

The SUMMIT Study will be delivered by UCLH in close collaboration with UCL and GRAIL, Inc., a US healthcare company focused on the early detection of cancer.

The study aims to recruit approximately 50,000 men and women aged 50-77 from north and east London. Half of the participants will be people at high risk of lung and other cancers due to a significant smoking history (Group A), and the other half will be people who are not at high risk for cancer based on smoking history (Group B). All participants will provide a blood sample, which GRAIL will analyse to evaluate whether lung or other cancers can be detected early through genomic signals in the blood.

Participants in Group A will be identified by inviting residents of north and east London who may meet the eligibility criteria based on their smoking history for a lung health check. In addition to providing a blood sample, participants who are eligible and decide to join Group A will be screened for lung cancer using a low dose CT scan (imaging technology proven to detect lung cancer). The SUMMIT Study will also offer smoking cessation support to smokers who would like to stop.

People in Group B will be invited via a letter from their general practitioner, and eligible and interested participants will also donate a blood sample and fill out a questionnaire.

One in two people will be diagnosed with cancer in their lifetime; lung cancer alone causes around 35,000 deaths per year in the UK. Early diagnosis is key to effective treatment and increasing survival for all cancers, but particularly for lung cancer: currently around 75% of lung cancers are diagnosed at a late stage – stages 3 and 4. Only 25% are diagnosed at the earlier stages 1 and 2.

If diagnosed at the earliest stage, 70% of lung cancer patients will survive for at least a year, compared to around 14% for people diagnosed with the most advanced stage of the disease.

Professor Geoff Bellingan (UCL Medicine), medical director for cancer and surgery at UCLH, said: “The SUMMIT Study provides us with a once-in-a-lifetime opportunity to change how lung cancer is diagnosed – both by paving the way for a national screening programme here in the UK and supporting global efforts to develop a novel blood test for early detection of multiple cancers, including lung cancer.”

Professor Mark Emberton (Dean, UCL Faculty of Medical Sciences), commented: “The SUMMIT study is wonderful opportunity to deliver cutting edge care to a large portion of London and save lives. We are working with a US company to build a team of clinicians and scientists that can really make a difference in the early detection of both lung cancer and other types of cancer through the development of blood tests.”

 

 

Full report in The Guardian (Open access)

 


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