Pilot feasibility study to deliver low-dose CT lung cancer screening in Scotland: descriptive findings from the LungScot study.

Abstract

To assess the feasibility and acceptability of delivering risk-stratified low-dose CT (LDCT) lung cancer screening across diverse geographical and socioeconomic settings in Scotland and to characterise uptake, participant profile and screening outcomes. Prospective, multicentre pilot feasibility study with descriptive analysis. Primary and secondary care interface across four regional Health Boards in Scotland, encompassing urban, rural, remote and socioeconomically deprived populations. 2801 individuals aged 50-74 years, identified from primary care electronic medical records (EMRs), with a history of smoking were invited (current or within 15 years where available); 668 (23.8%) responded. Of 608 assessed for eligibility (50.8% female; median age 63 years), 503 (82.7%) met at least one predefined high-risk criterion. Invitation to a lung health check, followed by telephone-based risk assessment using US Preventative Services Task Force, Liverpool Lung Pathway version 2 and the Prostate, Lung, Colorectal and Ovarian Screening Trial criteria. High-risk participants were offered a one-off LDCT scan at local centres. Primary: feasibility indicators including uptake, risk eligibility and scan completion. Secondary: prevalence of lung cancer, pulmonary nodules and incidental findings (eg, coronary artery disease, emphysema). Response rate was 23.8% (668/2801), varying from 17.8% to 38.1% across practices and lower in more deprived areas. Of 503 eligible participants, 436 (86.7%) underwent LDCT. Abnormal findings were present in 83.3% of scans. Lung nodules were detected in 25.7% (112/436), with 11.8% requiring follow-up. Lung cancer was diagnosed in 1.15% (5/436; 95%), alongside five additional malignancies. Coronary artery disease was identified in 56.4% (246/436) and emphysema in 33% (144/436). Non-responders were more likely to be current smokers (69.3% vs 49.8%). Recruitment of people for lung cancer screening using the smoking history recorded in their primary care EMR is feasible. This approach identifies a high-risk population with a high burden of both malignant and non-malignant disease, and with substantial undiagnosed disease burden. However, uptake was modest and socially patterned, highlighting the need for equity-focused implementation strategies, including repeated invitations and targeted engagement. These findings are particularly relevant as Scotland considers implementation of a national lung cancer screening programme within a health system characterised by marked geographical and socioeconomic inequalities. Further research should evaluate long-term outcomes, cost-effectiveness and strategies to improve equitable participation.