Symptom prevalence and impact on lung cancer risk in the SUMMIT study.

Abstract

Lung cancer screening is now widely adopted across healthcare systems. Screening typically occurs in asymptomatic individuals. As symptoms of lung cancer overlap with those of chronic conditions, defining asymptomatic screening is challenging. This study outlines the frequency of symptomatic participants in a lung cancer screening trial. How common are respiratory and red flag symptoms in lung cancer screening participants and how do these symptoms impact screening outcomes? SUMMIT is a prospective observational cohort study to assess the implementation of Low-Dose Computed Tomography (LDCT) screening for lung cancer. Baseline clinical assessments collected self-reported symptoms, medical history, demographics, and spirometry. Haemoptysis (in last year) and unintentional weight loss (≥5kg in 3 months) were classified as red flag symptoms, and cough (acute: onset less than six weeks, or chronic: >6 weeks) and dyspnoea (modified Medical Research Council scale≥1) classified as non-specific symptoms. Lung cancer diagnoses within one year were ascertained. Multivariable logistic regression was used to assess associations between symptoms and lung cancer. Among 13,035 participants eligible for a baseline LDCT 76% (N=9,859) reported at least one symptom. Cough was present in 36% (N=4,707) and 66% of participants reported dyspnoea. Only 6% of participants reported red flag symptoms, including hemoptysis and weight loss. The presence of any of these symptoms was associated with higher likelihood of lung cancer diagnosis in the year following assessment (OR 1.45, p=0.03, adjusted for other baseline factors). Symptoms are commonly reported in those undergoing lung cancer screening and those with symptoms are more likely to be diagnosed with lung cancer.