H Balata1, S Blandin Knight1, P Barber1, D Colligan2, E J Crosbie3, R Duerden4, P Elton5, M Evison1, M Greaves4, J Howells6, K Irion7, D Karunaratne7, M Kirwan8, A Macnab9, S Mellor10, C Miller9, T Newton10, J Novasio11, R Sawyer4, A Sharman4, K Slevin8, E Smith4, B Taylor11, S Taylor2, J Tonge2, A Walsham12, S Waplington2, J Whittaker13, R Booton1, P A J Crosbie14. 1. Manchester Thoracic Oncology Centre, North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK. 2. Manchester Health and Care Commissioning, Manchester, UK. 3. Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK. 4. Department of Radiology, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK. 5. Greater Manchester Health & Social Care Partnership, Manchester, UK. 6. Department of Radiology, Royal Preston Hospital, Preston, UK. 7. Department of Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK. 8. Thoracic Oncology Research Hub (TORCH), Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK. 9. Department of Cardiology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK. 10. Department of Radiology, Royal Blackburn Hospital, Blackburn, UK. 11. Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK. 12. Department of Radiology, Salford Royal NHS Foundation Trust, Salford, UK. 13. Department of Radiology, Stockport NHS Foundation Trust, Stockport, UK. 14. Manchester Thoracic Oncology Centre, North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK. Electronic address: philip.crosbie@manchester.ac.uk.
Abstract
BACKGROUND: Cardiovascular disease (CVD) is a major cause of morbidity and mortality in populations eligible for lung cancer screening. The aim of this study was to determine whether a brief CV risk assessment, delivered as part of a targeted community-based lung cancer screening programme, was effective in identifying individuals at high risk who might benefit from primary prevention. METHODS: The Manchester Lung Screening Pilot consisted of annual low dose CT (LDCT) over 2 screening rounds, targeted at individuals in deprived areas at high risk of lung cancer (age 55-74 and 6-year risk ≥1.51%, using PLCOM2012 risk model). All participants of the second screening round were eligible to take part in the study. Ten-year CV risk was estimated using QRISK2 in participants without CVD and compared to age (±5 years) and sex matched Health Survey for England (HSE) controls; high risk was defined as QRISK2 score ≥10%. Coronary artery calcification (CAC) was assessed on LDCT scans and compared to QRISK2 score. RESULTS: Seventy-seven percent (n=920/1,194) of screening attendees were included in the analysis; mean age 65.6 ± 5.4 and 50.4% female. QRISK2 and lung cancer risk (PLCOM2012) scores were correlated (r = 0.26, p < 0.001). Median QRISK2 score was 21.1% (IQR 14.9-29.6) in those without established CVD (77.6%, n = 714/920), double that of HSE controls (10.3%, IQR 6.6-16.2; n = 714) (p < 0.001). QRISK2 score was significantly higher in those with CAC (p < 0.001). Screening attendees were 10-fold more likely to be classified high risk (OR 10.2 [95% CI 7.3-14.0]). One third (33.7%, n = 310/920) of all study participants were high risk but not receiving statin therapy for primary CVD prevention. DISCUSSION: Opportunistic CVD risk assessment within a targeted lung cancer screening programme is feasible and is likely to identify a very large number of individuals suitable for primary prevention.
BACKGROUND: Cardiovascular disease (CVD) is a major cause of morbidity and mortality in populations eligible for lung cancer screening. The aim of this study was to determine whether a brief CV risk assessment, delivered as part of a targeted community-based lung cancer screening programme, was effective in identifying individuals at high risk who might benefit from primary prevention. METHODS: The Manchester Lung Screening Pilot consisted of annual low dose CT (LDCT) over 2 screening rounds, targeted at individuals in deprived areas at high risk of lung cancer (age 55-74 and 6-year risk ≥1.51%, using PLCOM2012 risk model). All participants of the second screening round were eligible to take part in the study. Ten-year CV risk was estimated using QRISK2 in participants without CVD and compared to age (±5 years) and sex matched Health Survey for England (HSE) controls; high risk was defined as QRISK2 score ≥10%. Coronary artery calcification (CAC) was assessed on LDCT scans and compared to QRISK2 score. RESULTS: Seventy-seven percent (n=920/1,194) of screening attendees were included in the analysis; mean age 65.6 ± 5.4 and 50.4% female. QRISK2 and lung cancer risk (PLCOM2012) scores were correlated (r = 0.26, p < 0.001). Median QRISK2 score was 21.1% (IQR 14.9-29.6) in those without established CVD (77.6%, n = 714/920), double that of HSE controls (10.3%, IQR 6.6-16.2; n = 714) (p < 0.001). QRISK2 score was significantly higher in those with CAC (p < 0.001). Screening attendees were 10-fold more likely to be classified high risk (OR 10.2 [95% CI 7.3-14.0]). One third (33.7%, n = 310/920) of all study participants were high risk but not receiving statin therapy for primary CVD prevention. DISCUSSION: Opportunistic CVD risk assessment within a targeted lung cancer screening programme is feasible and is likely to identify a very large number of individuals suitable for primary prevention.
Authors: Mamta Ruparel; Samantha L Quaife; Jennifer L Dickson; Carolyn Horst; Stephen Burke; Magali Taylor; Asia Ahmed; Penny Shaw; May-Jan Soo; Arjun Nair; Anand Devaraj; Emma Louise O'Dowd; Angshu Bhowmik; Neal Navani; Karen Sennett; Stephen W Duffy; David R Baldwin; Reecha Sofat; Riyaz S Patel; Aroon Hingorani; Sam M Janes Journal: Thorax Date: 2019-09-26 Impact factor: 9.102
Authors: Mikey B Lebrett; Haval Balata; Matthew Evison; Denis Colligan; Rebecca Duerden; Peter Elton; Melanie Greaves; John Howells; Klaus Irion; Devinda Karunaratne; Judith Lyons; Stuart Mellor; Amanda Myerscough; Tom Newton; Anna Sharman; Elaine Smith; Ben Taylor; Sarah Taylor; Anna Walsham; James Whittaker; Phil V Barber; Janet Tonge; Hilary A Robbins; Richard Booton; Philip A J Crosbie Journal: Thorax Date: 2020-07-06 Impact factor: 9.102