Population impact of risk-based lung cancer screening on late-stage incidence in Greater Manchester
Menée en Grande Bretagne à partir de données portant sur 221 240 personnes ayant bénéficié d'un dépistage du cancer du poumon par tomographie numérique à faible dose de rayonnement et menée à partir de données portant sur 982 130 personnes de régions ne proposant pas ce type d'intervention (âge : de 55 à 80 ans), cette étude estime le pourcentage de réduction de l'incidence des cancers du poumon de stade avancé après la mise en place du dépistage chez les personnes présentant un risque élevé de développer la maladie
Background : Low dose CT (LDCT) screening reduces lung cancer mortality in clinical trials, but evidence of impact in real-world programmes is lacking. Here we examine the impact of screening in a socio-economically deprived area at the population level. We hypothesised that late-stage lung cancer incidence, as a surrogate for lung cancer mortality, would decrease following systematic implementation of screening in a high-risk population.
Methods : Late-stage lung cancer incidence among individuals aged 55-80 at the time of screening invitation was compared before and after screening implementation between regions with and without implementation of community-based lung cancer screening (North & East Manchester [screening] vs 4 neighbouring regions [no screening]). The effect of screening was estimated using difference-in-difference modelling.
Results : Late-stage lung cancer incidence decreased more steeply in the screening region, such that screening was associated with a 22% reduction in late-stage lung cancer incidence among the invited age range 55-80 (adjusted incidence rate ratio, IRRadj 0.78, 95% CI 0.62-0.99, p=0.037). Targeted LDCT screening of 2.0% of the full North & East Manchester population (n=4,468/221,240) detected 31% of all lung cancers diagnosed since screening commenced (n=221/722), yielding a number-needed-to-screen of 20 for each cancer detected.
Conclusion : Implementation of targeted, community-based lung cancer screening in an area of high socioeconomic deprivation was associated with a significant reduction in late-stage lung cancer incidence. This provides a demonstration of screening effectiveness and public health benefit.
Journal of Thoracic Oncology , résumé, 2025