Researchers launch lung cancer screening trial

May 9 2008

Scientists are testing a new way of detecting lung cancer at an early stage in people at greatest risk of developing the disease.

The trial*, funded by Cancer Research UK, aims to see if screening long-term smokers with chronic obstructive pulmonary disorder (COPD) will lead to more cases of lung cancer being caught early. COPD is a degenerative lung condition - largely caused by smoking - that includes chronic bronchitis and emphysema, and increases the chance of developing lung cancer.

Lung cancer is very often diagnosed at a late stage, making it difficult to treat. If it can be diagnosed earlier, treatment is far more effective - significantly boosting survival. More than 100 people each day - 38,000 people a year - are diagnosed with lung cancer in the UK. But lung cancer has one of the worst survival rates of any cancer with only seven per cent of patients still alive five years after diagnosis. However, if some types of lung cancer are detected at an early, operable stage, then a five-year survival rate of up to 80 per cent can be achieved.

Lead researcher, Professor Stephen Spiro of University College London Hospitals NHS Foundation Trust (UCLH), said: "Many of the tests that have been used to screen for lung cancer have not been able to pick up very early signs of the disease so we're using two new tests which we think could be better at picking up lung cancer earlier."

Around half the patients on the trial will be asked to give a sample of phlegm for analysis once a year. If any abnormal cells are found, the patient will be asked to take two further tests to check the finding. The first test is a new type of scan called a spiral CT scan. The second test is called a fluorescence bronchoscopy, which uses blue and white light to examine the lining of the airways. This involves inserting a narrow flexible tube with a camera down the windpipe to look into the lungs and collect a tissue sample.

Professor Spiro added: "The cost of treating lung cancer remains an enormous burden on the NHS and sadly the disease is the UK's biggest cause of cancer death, with 33,000 patients dying each year. This trial is selectively screening people who are at high-risk of developing lung cancer and we hope this will eventually lead to a nationwide cost-effective screening programme that could save tens of thousands of lives."

1,300 smokers with COPD are being recruited to the trial - which is open in six hospitals** across the UK - over the next two years, with GPs inviting suitable patients to take part. Participants will be randomly assigned into one of two groups. Half will be in the control group and will continue to receive the standard care for COPD and have a chest x-ray after five years. The other half will be called once a year to give a blood sample and a sample of phlegm for analysis.

If the doctors find any abnormal cells in the tissue sample following the bronchoscopy and spiral CT scan, patients will be asked to have regular bronchoscopies. If the tissue sample shows only normal cells, patients will have a bronchoscopy and a CT scan once a year for the next five years.

Kate Law, director of clinical trials at Cancer Research UK, said: "We urgently need to find new ways of detecting lung cancer earlier, so that patients have a better chance of successful treatment. This is a very important trial and it may be the first step towards an effective screening test for lung cancer in those at high-risk of the disease.

"It's important to remember that nine of ten cases of lung cancer are caused by smoking so the best way to reduce your risk of developing lung cancer is by not smoking - or, if you're a smoker, by giving up. There is always a benefit to stopping smoking, whatever your age. We know that giving up is hard but help and support is available from your local GP or the NHS stop smoking service."

For further information, please contact the Cancer Research UK press office on 0207 061 8300 or, out-of-hours, the duty press officer on 07050 264 059.

Notes:

*The trial's full name is: Lung-SEARCH. Contact the Cancer Research UK Information Nurses for more information on 0808 800 4040 - lines are open from 9am to 5pm Monday to Friday.

**The trial is open at the following centres around the UK:

• University College Hospital, London
• Royal Brompton Hospital, London
• Papworth Hospital, Cambridge
• St James's Hospital, Leeds
• Glenfield Hospital, Leicester
• Chelsea and Westminster Hospital, London - not yet open

People can enter this trial if they:

• Have mild or moderate chronic obstructive pulmonary disease (COPD)
• Currently smoke and have smoked at least 20 cigarettes a day for 20 years or 40 cigarettes a day for 10 years, OR have smoked this much in the past and have given up in the last 8 years
• Are well enough to take part in this trial

People cannot enter this trial if they:

• Have had any other cancer in the last 5 years apart from non-melanoma skin cancer Have very poor lung function test results Have any other serious medical condition

Patients will continue receiving medical care for COPD during the trial. If any of the tests reveal lung cancer is present, patients will start treatment immediately, no matter what arm of the trial they are on. If any patients have symptoms of lung cancer during the trial, they will have further tests straight away.

Chronic obstructive pulmonary disorder (COPD)

COPD stands for chronic obstructive pulmonary disease. This is a term used for a number of conditions; including chronic bronchitis and emphysema.

COPD leads to damaged airways in the lungs, causing them to become narrower and making it harder for air to get in and out of the lungs. The word 'chronic' means that the problem is long-term.

The most common cause of COPD is smoking. Once you give up smoking, you gradually reduce the chances of getting COPD - and you slow down its progress if you already have it. Occupational factors, such as coal dust, and some inherited problems can also cause COPD.

Cough, phlegm and shortness of breath can be symptoms of COPD. Some people may only notice their symptoms in winter, or they might put them down to bronchitis or'smoker's cough'. This means that they might not seek help at an early stage of the disease. The sooner people seek treatment the better.

The symptoms of COPD vary depending on how bad it is, and how people have adapted to their problems. In mild cases, symptoms like a cough, phlegm and shortness of breath may only be present during the winter or after a cold. In more severe cases, you may be short of breath every day. With more severe COPD, because of breathlessness, normal activities can become more difficult.

COPD cannot be cured once you have it, but treatments may help. For most people, stopping smoking reduces the risk of developing COPD and also slows down its progression. However, some people develop COPD for other reasons which may be more difficult to prevent.