Why are We Waiting?

By Greg Pycroft, Policy and Public Affairs Manager

On the 29th September 2022 the UK National Screening Committee (UKNSC) recommended that the 4 UK nations should move towards implementing targeted national lung cancer screening programmes - integrated with smoking cessation services - for people at high risk, ever-smokers – people who smoke, or with a recent history of smoking.

Less than a year later, on the 26th June 2023, the UK Government announced the rollout of a targeted lung cancer screening programme across England. Initially delivered through local and regional research projects and pilots, around 25% of the at-risk population has received a lung health check. That figure will rise to 40% by 2025. The next phase will see the development of a national screening programme in England that will benefit from an integrated IT system and a safe, consistent, and effective pathway. The entire at-risk population will be covered by targeted lung cancer screening by 2030.

The decision to do so follows a successful opening phase where approximately 70% of the screening took place in mobile units parked in convenient places - such as supermarket car parks - to ensure easy public access and focused on less affluent areas. 

The UK NSC and UK Government decisions raise an important question for Wales, and the decision makers responsible; how long does Wales have to wait until a target lung cancer screening programme is available here, or at the very least ensure the pilot currently taking place within the Cwm Taf Morgannwg UHB area continues beyond 2023 and expands to cover more than the current 500 North Rhondda residents. After all, around 1800 people die every year from lung cancer in Wales, making it the biggest cause of cancer death.

Tenovus Cancer Care has taken a close interest in the need to tackle the impact of lung cancer across Wales. We published "Tackling Inequalities: Lung Cancer" last year. The report sets out the challenge posed by the disease in Wales, the inequalities at the heart of the problem, current preventative interventions and more innovative approaches being developed to identify and diagnose lung cancer earlier. 

So many people die from lung cancer because of late diagnosis. Around 45% of people are diagnosed with stage 4 lung cancer when the cancer may have spread around the body and fewer treatment options exist.  

Yet despite its seriousness, a lung cancer diagnosis need not be a death sentence.  Caught early enough, rates of survival are reasonably high.

Also, across Wales lung cancer is not experienced equally. The disease is linked to inequalities and takes a terrible toll on disadvantaged communities.

Everyone deserves the same chance of survival from lung cancer. Tackling inequality is a priority for Tenovus Cancer Care, it’s at the heart of everything we do, and has informed our desire to implement new and innovative ways to catch lung cancer earlier.

Tenovus Cancer Care has been closely involved in the development of a lung health check operational pilot. As a 3rd sector partner, we helped secure the pharmaceutical industry funding behind the 500 lung health checks given to eligible residents in the Cwm Taf University Health Board area from September to December 2023.

Despite the recommendation of the UKNSC, and poor lung cancer outcomes across Wales, the “operational pilot” is the only pilot, project or programme of work in Wales delivering any kind of targeted lung cancer screening.

By comparison, across the border in England, over a million people have received their invitations to attend a lung health check. Between 3% to 6% of those people will be diagnosed with lung cancer and well over half will be at an early stage (1 and 2), before symptoms such as coughing. Treatment at those stages will contribute to higher survival rates and lower rates of death.  

The introduction of targeted lung cancer screening across Wales could prevent more than 20% of lung cancer deaths amongst those screened and improve health outcomes for many more patients.

Many lives could be saved by diagnosing people before they present to their GP or accident and emergency with symptoms.

Despite expressing support in principle there remains no firm commitment and timetable from the Welsh Government to implement the UKNSC recommendation in Wales.

Potential delivery partners and stakeholders are unfortunately left in the dark. We wait for the Welsh Government to act, but Tenovus Cancer Care is committed to raising awareness of targeted lung cancer screening and the lung health check programme being rolled out across England.  

The third sector has decided to act. We are campaigning to increase public and political awareness of targeted lung cancer screening.

Members of the public can help us call for change. Between the 1^st November 2023 and the 30^th April 2024 you can sign a Senedd petition calling on the Welsh Government to act. We want to secure 10,000 signatures to force a debate in the Senedd to enable MSs to make the case for targeted lung cancer screening in Wales’ primary decision-making forum.  

Experts accept that there is nothing on the horizon – no technology, tool, treatment or intervention - that will have a bigger short-to-medium term difference on lung cancer mortality and cancer inequality than targeted lung cancer screening. While we might need to wait to secure the funding, Wales can’t afford to wait to start planning for its fourth cancer screening programme.

Even though there is an effective pathway for early lung cancer diagnosis – tried and tested, saving lives in England, and will save the NHS money in the long term, Wales waits.

Even though there is a not insignificant risk that the lung cancer screening workforce will be attracted to a more certain future across the border, Wales waits.

Glossary

Lung Health Check – the evidence-based programme, and NHS pathway, delivering the targeted lung cancer screening as well as smoking cessation advice and the potential diagnosis of other lung health conditions.

Targeted Lung Cancer Screening – the evidence-based act of giving people between 55 and 74 and at higher risk of lung cancer a low-dose computerised tomography (CT) scan. Done on a biennial basis with the aim of detecting lung cancers at an earlier stage when they are more survivable.