Major new study may lead to earlier detection of lung cancers

A major new study, which has recently begun recruiting, is hoped to lead to earlier detection of lung cancers.

People living in Leeds, Bath, Hull and Stoke-on-Trent will be among those approached to take part. The study is funded by National Institute for Health and Care Research (NIHR).

At the moment, chest X-ray is the test GPs are advised to use in almost for almost all symptoms to rule out or confirm a cancer. Symptoms can include a cough that persists for several weeks.

Worryingly, however, chest X-rays are not always conclusive. Indeed, it's believed that they miss as many as 20 per cent of lung cancers.

More people in the UK die from lung cancer than from any other cancer - which is why earlier detection of the cases not diagnosed by X-ray could potentially save many lives.

Researchers strongly suspect that low-dose CT scans – far more accurate than X-rays - are likely to do just that. But until now, no one has yet done a large study comparing the two methods in patients with symptoms.

Within the last two months, a team of researchers and academics - from the Universities of Leeds, Sheffield, Exeter and Nottingham, plus Queen Mary University of London and University College London - have started the process of recruiting 900 volunteers for the new study.

Patients who visit their GP to talk about worrying respiratory symptoms will be approached after their GP requests an x-ray for them.

All chest X-rays will go ahead as planned, but patients who agree to take part in the study – called MEDLEY - will also be given a low-dose CT scan. Results from the scan – which may include respiratory diseases other than cancer - will be passed on immediately to the patient's doctor.

Patients will be given reading material about the entire process and have phone and email access to a specialist researcher. Reassuringly, low-dose CT scans provide only as much radiation as a person receives from their normal environment in a week.

So, could low-dose CT scans end up replacing chest X-rays as a first-line cancer test?

Ideally, yes – but the scans are more expensive than X-rays and take longer to carry out.

Given the extra patients that may get an earlier cancer diagnosis if the scheme is adopted nationally, the Department of Health may agree to swallow the extra cost. However, NHS resources are stretched – so one possible outcome of the study is that only certain patients may be prioritised for scans rather than X-rays.

Bearing this in mind, MEDLEY researchers will work out if risk factors, such as age and smoking history, can be used to decide who is most likely to benefit from a low-dose scan rather than a chest X-ray.

Lung cancer is still our biggest cancer killer - and even with new services like screening for people at high risk, most people will still be diagnosed after having a chest X-ray organized by their GP."

Professor Mat Callister, one of the leading MEDLEY team members

'We need to diagnose lung cancer early, when treatments are most effective, and we know lung cancer isn't always picked up on chest X-ray. However, the NHS may struggle to do CT scans for all the patients who currently have chest X-rays.

'MEDLEY will give us some answers as to whether all these patients should have a CT scan instead of a chest X-ray, or whether we can at least identify some patients who are at highest risk." 

Professor Anthony Gordon, Programme Director for the NIHR Health Technology Assessment (HTA) Programme, said:

"Tackling some of the biggest killers, such as lung cancer, and funding researchers to help them identify more effective ways to accurately identify these illnesses forms a vital part of NIHR's work. 

"It's crucial we fund studies like this, which aim to identify the most suitable treatments and offer those affected the best possible chance of living healthier lives for longer."

The study, which is expected to conclude within three years, has secured £1.2 million in funding from the NIHR.