Lung health checks in car parks?

An idea that reduces costs and saves lives: As part of its long-term plan, the UK’s National Health Service (NHS) has decided to proactively invite risk groups to free cancer screenings.

Andrea Lutz
Published on May 25, 2022

The UK is showing just how simple cancer screening can be: High-risk patients are examined within a few minutes, get certainty about the state of their lung health, and don’t even have to go to the hospital. The CT scan needed for the lung check is performed in a converted motorhome in a supermarket car park – so patients can get screened on their way to the shops.

<p>Lung cancer is a tumor with a bad prognosis: On average, only one in five patients survives the first five years after diagnosis.[1] As is the case with all cancer types, the prognosis depends on the stage at which the disease is detected. Patients have a better chance of survival if the cancer is discovered at stage 1 or 2 – or at least well before the first symptoms arise.</p>
The earlier the cancer is detected, the better it can be treated and in some cases even cured. But early detection is often very difficult: Lung cancer rarely causes any symptoms in the early stages, and the typical symptoms only occur when the disease is advanced. This means it is frequently discovered late – in many cases too late. In particular, small and therefore more harmless tumors are usually detected accidentally, such as when the lung has to be X-rayed for other reasons.
Tumor specification
<p>Several studies have already shown that lung cancer screening with low-dose computed tomography (LDCT) scans can prolong life. Back in 2011, the National Lung Screening Trial in the USA showed a reduction in cancer-specific mortality in high-risk patients. The more recently published European NELSON trial came to the same conclusion: A decade after the screening program started, death rates due to lung cancer amongst smokers and former smokers who were examined with an LDCT scan were 24% lower for men and 33% percent lower for women, compared with the control group that was not screened.[2] Similarly, the German LUSI study and the ITALUNG study from Tuscany indicate reduced mortality from lung cancer amongst patients who received LDCT screening.[3]</p>
<p>The UK Lung Cancer Screening Trial paved the way for showing the relevance of screening programs in the UK. The trial included 3,968 people in Liverpool and Cambridge, all in the 50–75 age group. Around 75% were male and the average age was 68. For all participants, the risk of developing lung cancer within five years was assessed as particularly high. Between October 2011 and February 2013, about half (1,987 participants) were examined with a CT scan. The remaining participants received the usual care provided by the NHS, but no CT scan. Each patient was observed and monitored for seven years. During this period, 86 cases of cancer were detected in those in the screening program, while only 75 cases were detected in patients who received the standard medical care. The result was also interesting with respect to <a href="mortality">mortality</a>: 46 of the patients who received no CT examination died within a period of seven years, while only 30 of those from the screening program died.[4]</p>
Mortality is the death rate for a particular disease.
<p>Founded in 1948, the National Health Service (NHS) is still a publicly funded state health system today. Unlike e.g., in Germany, the UK has no statutory health insurance. The British health system is based on the concept of the welfare state, which the British MP William Beveridge set out in the <a href="Beveridge%20Report">Beveridge Report</a>. That is why the public health system is funded by tax revenue and nearly all medical services in the UK are free.</p>
A report that provided the foundation for the social insurance systems in postwar Britain, in particular the NHS.
<p>Thirteen percent of all cancer patients in the UK have lung cancer [5], and around 48,500 people receive this diagnosis each year.[6] The number of smokers in the UK has decreased significantly in the last few years, but cigarette consumption still costs smokers more years of life than any other influencing risk factor. Therefore, the overarching and long-term plan of the NHS is to protect those sections of the population that are most at risk – first and foremost smokers. The aim: By 2028, an additional 55,000 people each year will survive for five years or more after their cancer diagnosis.[7] <br><br>Considerable efforts are being made to achieve this ambitious aim. For example, screening programs are to be expanded by establishing Rapid Diagnostic Centres throughout the country. These will allow patients with relevant symptoms to be examined quickly without long waiting times.</p>
One pilot project of the NHS is the Manchester program that was launched in 2019. The program was introduced across the north of the city. Why there? Because this is the region with the highest number of lung cancer deaths amongst under-75s in England.

Professor Richard Booton, Clinical Director of Thoracic Oncology and Director of the Manchester Lung Health Check Programme at Manchester University NHS Foundation Trust

To achieve this aim, sections of the population most at risk – i.e., smokers and former smokers in the 55–74 age group – were examined in a mobile scanning unit. A total of 2,571 people took up the offer of a lung CT scan provided in a specially converted motorhome parked in a supermarket car park. It was a success: As part of the program, 65 hitherto undetected cancer cases were found . Eighty percent of the patients received their diagnosis at stage 1 and 2, when the prognosis is still favorable.
For the screening exams in the Manchester area, a commercially available motorhome was equipped with a SOMATOM go. CT scanner. The idea now is to use this approach to reach 600,000 individuals in the UK within the next five years. Not every initiative will use mobile scanners – each region can decide for itself which measure makes most sense. The NHS is hoping that the initiative will save several hundred lives thanks to early diagnosis. Initially, all projects are to run for four years and will then be evaluated to assess whether the initiative should be continued.
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CT scans can produce especially precise and detailed slice images of smaller tumors. They are particularly useful for assessing the extent to which a tumor has spread. But there is also a disadvantage: This type of imaging uses X-rays that can be harmful to humans, especially if used in regular screening examinations. Developers are therefore continually working on refining scanner technology to reduce the radiation dose while maintaining the same image quality.
lung cancer screening with low-dose CT
<p>One example of this is Tin Filter technology, which is fitted in all SOMATOM go. scanners used in the Manchester program. During a scan, the X-ray tube produces an energy spectrum that depends on the anode material. The Tin Filter filters out low-energy photons so that they don’t reach the patient. This means that they don’t affect the total effective dose, fewer artifacts occur, and the image quality is better.<br><br>Siemens Healthineers made another major breakthrough in 2021 with the market launch of the first photon-counting CT scanner: <a href="/perspectives/photon-counting-ct">NAEOTOM Alpha</a>. The new system produces images that, even to the naked eye, look sharp and more detailed than images from a conventional CT scanner. This is because the detector directly transforms the photons’ energy into electrical signals. This provides high spatial resolution, and the precise allocation of the photons reduces the dose required and minimizes image noise.</p>
<p>The battle against cancer – as shown by the efforts of the Cancer Alliance areas in England – can only be won if we work together. Due to the abnormal situation caused by the COVID-19 pandemic, screening appointments have slipped a long way down the list of priorities for many people. That is why many experts describe cancer as another pandemic – one that claims many more lives than COVID-19. The <a href="World%20Economic%20Forum">World Economic Forum</a> will therefore be addressing the topic of cancer screening at its annual meeting in May.</p>
The World Economic Forum is a foundation that provides the public, business leaders, policymakers, and academics with a platform for debating controversial topics.
Every human life saved is justification enough for launching initiatives like the one in Manchester. However, screening also makes financial sense for health services. For tax-financed systems in particular, it is essential that the costs for patient care do not spiral out of control. Scientists from Helmholtz Zentrum München have produced some interesting figures on what lung cancer actually costs. They examined data from more than 17,000 lung cancer patients in Germany and observed the trends over three years. Their findings showed that the highest treatment costs are incurred in the first six months after diagnosis because that is the period when cancer patients are often being treated in hospital. The average cost per case during this period is around €20,000 for the treatment of lung cancer. However, while radiation therapy and surgery accounted for around €26,000 and €20,000 respectively, some cases only cost €4,200 because no cancer-specific therapy was recommended.[11]
The scientists showed that around a third of patients were treated surgically and that their prognosis was significantly better compared with patients who were treated with radiotherapy or chemotherapy. They made the case that further developing screening measures is very important as it increases the chance of diagnosis during an operable stage of the disease and so raises the chance of treating the disease both conservatively and curatively.

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By Andrea Lutz
Andrea Lutz is a journalist and business trainer specialized on medical topics, technology, and healthcare IT. She lives in Nuremberg, Germany.