Lung cancer kills more people in the UK than any other cancer. Mortality rates are poor, with fewer than 10% of people alive 10 years after diagnosis. Lung Cancer Screening (LCS) with low-dose CT (LDCT) is effective at reducing lung cancer mortality when employed in at-risk populations; because of this, in the US, LCS has been implemented as a national programme. The UK does not currently screen for lung cancer, but in 2019 NHS England announced a pilot scheme to implement lung health checks (LHC) in areas with the poorest lung cancer outcomes. Despite these advances in LCS in the UK, there are outstanding questions about how LCS could be implemented safely and effectively, which this thesis, based on experience and data from the SUMMIT Study, aims to investigate. To provide screening safely, implementation of any study or programme must focus on maintaining a favourable cost to benefit ratio. This is particularly true in LCS where high false positive and overdiagnosis rates, as well as considerable levels of incidental findings, lead to possible psychological stress, needless investigations and interventions, making provision challenging to both screenees and healthcare providers. The SUMMIT Study investigates how to deliver evidence-based LCS in a large population (25,000), and this thesis in particular focusses on how LCS can be streamlined through proformatisation of radiological data collection, clinical actioning of results and standardised communication with general practitioners (GPs) and participants. This thesis explains the approach to managing pulmonary nodules and incidental findings detected at LDCT in SUMMIT, and how these findings are collected, triaged, and communicated in a way that is both efficient and safe. Early data from SUMMIT is presented to understand how evidence-based proformas may enable streamlined clinical management, data collection and results communications, while decreasing the burden on healthcare professionals and participants alike
