Lung Cancer Screening Advisory Group - June 2017

Minutes of the Lung Cancer Screening Advisory Group
held on Monday 12 June 2017, CAN Mezzanine, London

Present:
Peter Sasieni, Independent Chair (PS)
David Baldwin, Respiratory Physician – lung screening expert (DRB)
Sion Barnard, Thoracic Surgeon (SB)
John Field, CI : UKLS (JFi)
Barbara Gill, ACE programme: lung cancer lead (BG)
Sam Janes, Clinical/laboratory lung cancer expert (SJ)
Robert Rintoul, Translational medicine – lung cancer expert (RR)
Martin Grange, lay representative (MG)
Janette Rawlinson, lay representative (JR)
Tim Elliot, Senior Policy Advisor DoH (TE)
Amelia Randle, GP and clinical cancer lead (AR)
Jesme Fox, Roy Castle Lung Cancer Foundation Medical Director (JF)

In attendance: Jackie Tebbs, Roy Castle Lung Cancer Foundation: Secretariat Administrator (JT)

Apologies:
Anand Devaraj, Radiologist: lung imaging expert (AN)
Stephen Duffy, Statistician/epidemiologist – lung cancer screening expert (SD)
Mick Peake, National Lung Cancer Audit Programme – clinical lead (MP)
Ed Gaynor, Clinical Lead for Cancer, NHS Liverpool CCG  

1. Welcome and apologies
The Chair, Prof Peter Sasieni, welcomed all to the meeting.

Apologies were noted from Anand Devaraj (AN), Stephen Duffy (SD), Mick Peake (MP) and Ed Gaynor (EG).  

2. Terms of Reference (updated)
The revised Terms of Reference were accepted and it was agreed these should be revisited in 12 months’ time. 

3. Review of draft report for NIHR and the UK National Screening Committee on lung cancer screening by low-dose CT
The LCSAG were given a short window of opportunity on which to comment on the NIHR and UKNSC report on lung cancer screening by low dose CT and the meeting focussed on this report.
The group raised various concerns, which included:   

  • The published evidence on CT screening was presented in a negative way, with overemphasis on lower quality trials. The report requires better balance to emphasise the attributes of CT screening that are based on better evidence.
     
  • The emphasis on random-effects meta-analysis resulted in small trials receiving almost as much weighting as the one very large trial. The group felt that this was inappropriate.  The way in which mortality was presented seemed backwards, with the conclusion that there is no statistical difference in lung cancer mortality, but with the inclusion of a trial that was later excluded (and which is known to be of poor quality).
     
  • The interpretation of psychological harm exaggerated the severity of the effects of CT screening.
     
  • The comments on lack of convincing evidence on smoking cessation need to be reconsidered using UKLS data.
     
  • The impact of combining smoking cessation with CT screening needs to be emphasised and combined with the cost effectiveness analysis.
     
  • Lack of meaningful PPI with no input from lung cancer patients/carers.
     
  • General issues raised about screening were general issues facing every national screening programme, so not exclusive to a potential lung screening programme.
     
  • Some statistics were incorrect.

To date the LCSAG have not received a response to the comments submitted and have not received an updated report.

Action points: 

  • DRB to request an updated draft of the report from Tristan Snowsill / Chris Hyde.
     
  • PS to write to the NSC advising that the LCSAG would like an opportunity to comment on the final report and what is the most appropriate way of doing so.
     
  • Consideration to be given to writing an editorial meta-analysis on mortality / psychosocial end points.   

4. Publication updates

Discussion took place on other lung health checks taking place and any published data available in order to get context. BG updated that there are several projects which will be summarised within the ACE report (Liverpool, Manchester, London, Nottingham), however, these are at various stages and data isn’t yet available for the full report.

Consideration to be given to the merits of UKLS publishing their data ahead of NELSON. PS and JFi to discuss this further outside of the meeting.  

The LCSAG consider that the evidence is strongly in favour of screening; screening will reduce mortality and will be cost effective. The various projects taking place will influence implementation and give an insight as to what methods work best.

It was agreed that the group would look at drafting an implementation plan, which would consider, for example, how to bring people in, how to approach the population, risk models and procedures, with various people leading on sections of the plan.  

Action:
Table of contents for implementation to be drawn up by 15 September meeting, followed by a 2 day brainstorming (with individual chapters submitted beforehand).  

5. Any other business There being no further business, the meeting closed.

Date of next meeting: Friday 15 September, London

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