David R Baldwin

• MD, FRCP
• Consultant at National Health Service

The effectiveness of screening programmes is critically dependent on the accuracy of the screening test. Where this relies on clinical expertise, there is an imperative to assure that the level of expertise meets expected standards. In cancer screening involving images, the focus is on the reader. Auditing of results is fraught with difficulty beca...

Background Lung cancer is a leading cause of mortality, yet disparities in lung cancer across different sociodemographic groups in the UK remain unclear. This study investigates ethnicity and sociodemographic disparities and differences in lung cancer in a nationally representative English cohort, aiming to highlight inequalities and promote equita...

Introduction In a small percentage of patients, pulmonary nodules found on CT scans are early lung cancers. Lung cancer detected at an early stage has a much better prognosis. The British Thoracic Society guideline on managing pulmonary nodules recommends using multivariable malignancy risk prediction models to assist in management. While these gui...

Background Screening for lung cancer with low radiation dose computed tomography has a strong evidence base, is being introduced in several European countries and is recommended as a new targeted cancer screening programme. The imperative now is to ensure that implementation follows an evidence-based process that will ensure clinical and cost effec...

Background: Screening for lung cancer with low radiation dose computed tomography has a strong evidence base, is being introduced in several European countries and is recommended as a new targeted cancer screening programme. The imperative now is to ensure that implementation follows an evidence-based process that will ensure clinical and cost eff...

Background Global annual cancer incidence is forecast to rise to 27.5 M by 2040, a 62% increase from 2018. For most cancers, prevention and early detection are the most effective ways of reducing mortality. This study maps trials in cancer screening, prevention, and early diagnosis (SPED) to identify areas of unmet need and highlight research prior...

Introduction Chronic Obstructive Pulmonary Disease (COPD) is underdiagnosed, and measurement of spirometry alongside low-dose computed tomography (LDCT) screening for lung cancer is one strategy to increase earlier diagnosis of this disease. Methods Ever-smokers at high risk of lung cancer were invited to the Yorkshire Lung Screening Trial for a L...

Lung cancer is one of the most deadly cancers in the world. Its mortality rate is high when the cancer is diagnosed late. Therefore, early detection is a crucial factor for an increase in survival rate, and lung cancer screening is one of the most important intervention tools. However, the screening would be cost-effective only when we can accurate...

Lung cancer has the highest cancer mortality rate in the UK. Most patients are diagnosed at an advanced stage because common symptoms for lung cancer such as cough, pain, dyspnoea and anorexia are also present in other diseases. This partly attributes towards the low survival rate. Therefore, it is crucial to screen high risk patients for lung canc...

Lung cancer screening with low-dose CT was recommended by the UK National Screening Committee (UKNSC) in September, 2022, on the basis of data from trials showing a reduction in lung cancer mortality. These trials provide sufficient evidence to show clinical efficacy, but further work is needed to prove deliverability in preparation for a national...

Background: Lung cancer is the second most common cancer in incidence and the leading cause of cancer deaths worldwide. Meanwhile, lung cancer screening with low-dose CT can reduce mortality. The UK National Screening Committee recommended targeted lung cancer screening on Sept 29, 2022, and asked for more modelling work to be done to help refine...

Importance Annual low-dose computed tomographic (LDCT) screening reduces lung cancer mortality, but harms could be reduced and cost-effectiveness improved by reusing the LDCT image in conjunction with deep learning or statistical models to identify low-risk individuals for biennial screening. Objective To identify low-risk individuals in the Natio...

Pulmonary nodules are a common finding on computed tomography (CT) scans of the chest. In the United Kingdom (UK) management should follow British Thoracic Society (BTS) Guidelines, which were published in 2015. This review covers key aspects of nodule management also looks at new and emerging evidence since then.

It is now widely accepted that lung cancer screening through low dose computed tomography (LDCT) results in fewer diagnoses at a late stage, and decreased lung cancer mortality. Whilst reducing deaths from lung cancer is an essential prerequisite, this must be balanced against the considerable economic costs accumulated in screening. Multiple healt...

Background: Optimising smoking cessation services within a low radiation-dose computed tomography (LDCT) lung cancer screening programme has the potential to improve cost-effectiveness and overall efficacy of the programme. However, evidence on the optimal design and integration of cessation services is limited. We co-developed a personalised cess...

This ERS guideline is dedicated to the provision of good quality recommendations in lung cancer care. All the clinical recommendations contained were based on a comprehensive systematic review and evidence syntheses based on eight PICO questions. The evidence was appraised in compliance with the Grading of Recommendations, Assessment, Development a...

Introduction and Objectives Lung cancer remains the leading cause of cancer mortality worldwide, with a known reduced mortality when diagnosed at an early stage. Approximately 2–4% of pulmonary nodules identified on CT as part of Lung Cancer Screening (LCS) programmes are due to lung cancer.Our prospective observational study, Artificial Intelligen...

The Lung Cancer Policy Network has published its first report, Lung cancer screening: learning from implementation. The report showcases the wealth of existing research on low-dose computed tomography (LDCT) screening for lung cancer, and includes 15 case studies from around the world that demonstrate the success of screening implementation program...

Background Optimising smoking cessation services within a low radiation-dose computed tomography (LDCT) lung cancer screening programme has the potential to improve cost-effectiveness and overall efficacy of the programme. However, evidence on the optimal design and integration of cessation services is limited. We co-developed a personalised cessat...

Background Many countries are introducing low‐dose computed tomography screening programmes for people at high risk of lung cancer. Effective communication strategies that convey risks and benefits, including unfamiliar concepts and outcome probabilities based on population risk, are critical to achieving informed choice and mitigating inequalities...

Objectives Successful lung cancer screening delivery requires sensitive, timely reporting of low-dose computed tomography (LDCT) scans, placing a demand on radiology resources. Trained non-radiologist readers and computer-assisted detection (CADe) software may offer strategies to optimise the use of radiology resources without loss of sensitivity....

Lung cancer is the leading cause of cancer-related deaths worldwide, primarily because most people present when the stage is too advanced to offer any reasonable chance of cure. Over the last two decades, evidence has accumulated to show that early detection of lung cancer, using low-radiation dose computed tomography, in people at higher risk of t...

Several countries mandate informed or shared decision-making for low-dose computed tomography (LDCT) lung cancer screening, but there is limited knowledge about the type of information and presentation techniques used to support decision-making in practice. This review aimed to characterise the content, format, mode, and presentation methods of dec...

Lung cancer screening is effective if offered to people at increased risk of the disease. Currently, direct contact with potential participants is required for evaluating risk. A way to reduce the number of ineligible people contacted might be to apply risk-prediction models directly to digital primary care data, but model performance in this setti...

Objective: We propose a risk-tailored approach for management of lung cancer screening results. This approach incorporates individual risk factors and LDCT image features into calculations of immediate and next-screen (1-year) risks of lung cancer detection, which in turn can recommend short-interval imaging or 1-year or 2-year screening intervals...

Background The NLST reported a significant 20% reduction in lung cancer mortality with three annual low-dose CT (LDCT) screens and the Dutch-Belgian NELSON trial indicates a similar reduction. We present the results of the UKLS trial. Methods From October 2011 to February 2013, we randomly allocated 4 055 participants to either a single invitation...

The concept of cure from cancer is important to patients, but can be difficult to communicate in terms that are meaningful. This is because there are a number of definitions of cure that are applied by clinicians, patients and the public, and by policymakers that have a different meaning and significance. In this article, we provide a narrative rev...

A high proportion of lung cancer cases are detected at a late cancer stage when they present with symptoms to general practitioners (GP). Early diagnosis is a challenge because many symptoms are also common in other diseases. Therefore, this study aims to assess UK primary care data of patients one, two and three years prior to lung cancer diagnosi...

The National Health Service England (NHS) classifies individuals as eligible for lung cancer screening using two risk prediction models, PLCOm2012 and Liverpool Lung Project-v2 (LLPv2). However, no study has compared the performance of lung cancer risk models in the UK. We analysed current and former smokers aged 40–80 years in the UK Biobank (N =...

Although there is now strong evidence for the efficacy of low-radiation dose computed tomography in reducing lung cancer mortality, the challenge is to establish screening programmes that have the maximum impact on the disease. In screening programmes, participation rates are a major determinant of the success of the programme. Informed uptake, par...

In most randomised controlled trials of low radiation dose computed tomography (LDCT) screening for lung cancer, eligibility has been determined by age and tobacco smoking criteria [1, 2]. A number of multivariable risk prediction models have been developed that are more sensitive and specific, but are still heavily dependent on smoking and age [3]...

Lung cancer is the leading cause of cancer-related deaths worldwide, accounting for almost a fifth of all cancer-related deaths. Annual computed tomographic lung cancer screening (CTLS) detects lung cancer at earlier stages and reduces lung cancer-related mortality among high-risk individuals. Many medical organizations, including the United States...

Introduction: Lung cancer is the world's leading cause of cancer death. Low-dose computed tomography (LDCT) screening reduced lung cancer mortality by 20% in the US National Lung Screening Trial. Here, we present the Yorkshire Lung Screening Trial (YLST), which will address key questions of relevance for screening implementation. Methods and anal...

Screening for lung cancer with low radiation dose CT has been shown to be effective in reducing lung cancer mortality by two major randomised controlled trials. Lung cancer screening is set to become the largest targeted cancer screening programme globally, but the effectiveness of the programme is dependent on many different factors. This article...

Rapid and continuing advances in biomarker testing are not being matched by take-up in health systems, and this is hampering both patient care and innovation. It also risks costing health systems the opportunity to make their services more efficient and, over time, more economical. This paper sets out the potential of biomarker testing, the unfoldi...

Rapid and continuing advances in biomarker testing are not being matched by take-up in health systems, and this is hampering both patient care and innovation. It also risks costing health systems the opportunity to make their services more efficient and, over time, more economical. The potential that genomics has brought to biomarker testing in dia...

The Lung Screen Uptake Trial tested a novel invitation strategy to improve uptake and reduce socioeconomic and smoking-related inequalities in lung cancer screening (LCS) participation. It provides one of the first UK-based ‘real-world’ LCS cohorts. Of 2012 invited, 1058 (52.6%) attended a ‘lung health check’. 768/996 (77.1%) in the present analysi...

Objectives Stereotactic Ablative Radiotherapy (SABR) is a well-established treatment for medically inoperable peripheral stage I non-small cell lung cancer (NSCLC). Previous non-randomised evidence supports SABR as an alternative to surgery, but high quality randomised controlled trial (RCT) evidence is lacking. The SABRTooth study aimed to establi...

Lung cancer screening (LCS) with low-dose computed tomography (LDCT) was demonstrated in the National Lung Screening Trial (NLST) to reduce mortality from the disease. European mortality data has recently become available from the Nelson randomised controlled trial, which confirmed lung cancer mortality reductions by 26% in men and 39-61% in women....

The Dutch-Belgian NELSON trial recently confirmed that screening for lung cancer with low radiation dose computed tomography (LDCT) reduces lung cancer mortality (1). This is a major contribution and has been long-awaited by some countries to support calls for implementation of screening programmes. NELSON has also provided invaluable information a...

Rationale PD-L1 expression on cancer cells is a clinically important biomarker to select NSCLC patients for treatment with PD-1/PD-L1 inhibitors. Clinical trials of immunotherapy in patients with non-small cell lung cancer have required histology for PD-L1 testing, while in clinical practice cytology samples are commonly acquired in patients with a...

Rationale: Individuals eligible for lung cancer screening (LCS) by low-dose computed tomography (LDCT) are also at risk of Chronic Obstructive Pulmonary Disease (COPD) due to age and smoking exposure. Whether the LCS episode is useful for early detection of COPD is not well established. Objectives: To explore associations between symptoms, comor...

Background Estimation of the risk of malignancy in pulmonary nodules detected by CT is central in clinical management. The use of artificial intelligence (AI) offers an opportunity to improve risk prediction. Here we compare the performance of an AI algorithm, the lung cancer prediction convolutional neural network (LCP-CNN), with that of the Brock...

Objectives: We conducted a systematic review and meta-analysis of survival following treatment recommended by the European Society of Medical Oncology for SCLC in order to determine a benchmark for novel therapies to be compared with. Materials and methods: Randomized controlled trials and observational studies reporting overall survival followi...

Background Approximately 15%–20% of all non-small cell lung cancer (NSCLC) cases present with stage I disease. Surgical resection traditionally offers the best chance of a cure but some patients will not have this treatment due to older age, comorbidities or personal choice. Stereotactic ablative radiotherapy (SABR) has become an established curati...

Rationale: Low uptake of low-dose CT (LDCT) lung cancer screening, particularly by current smokers of a low socioeconomic position, compromises effectiveness and equity. Objectives: To compare the effect of a 'targeted, low burden and stepped' invitation strategy versus control, on uptake of hospital-based 'Lung Health Check' appointments offeri...

Introduction and objectives The success of lung cancer screening (LCS) with low-dose CT (LDCT) depends critically on delivering timely, accurate radiology reports. Its anticipated widespread introduction will place a significant burden on current thoracic radiologist capacity, mandating innovative solutions. We explored the role that trained radiog...

Introduction Lung cancer screening (LCS) by low-dose CT has been shown to improve mortality, but individuals must consider the potential benefits and harms before making an informed decision about taking part. Shared decision-making is required for LCS in USA, though screening-eligible individuals’ specific views of these harms, and their preferenc...

Introduction Lung cancer screening (LCS) by low-dose computed tomography (LDCT) offers an opportunity to impact both lung cancer and coronary heart disease mortality through detection of coronary artery calcification (CAC). Here, we explore the value of CAC and cardiovascular disease (CVD) risk assessment in LCS participants in the Lung Screen Upta...

Purpose: Appropriate lung nodule management is essential to minimizing unnecessary patient recall in lung cancer screening. Two European guidelines provide differing recommendations in that participants with nodules ≥100 mm3 or ≥80 mm3 respectively should be recalled, at baseline. Nodule size estimation is known to vary between volumetry software...

Lung cancer is the commonest cause of cancer-related death worldwide and poses a significant respiratory disease burden. Little is known about the provision of lung cancer care across Europe. The overall aim of the Task Force was to investigate current practice in lung cancer care across Europe. The Task Force undertook four projects: 1) a narrativ...

Raman spectroscopy mapping was used to study ex vivo fresh lung tissues and compare to histology sections. The Raman mapping measurements revealed differences in the molecular composition of normal lung tissue, adenocarcinoma, and squamous cell carcinoma (SCC). Molecular heterogeneity of the tissue samples was well captured by the k -means clust...

Background Estimation of the clinical probability of malignancy in patients with pulmonary nodules will facilitate early diagnosis, determine optimum patient management strategies and reduce overall costs. Methods Data from the UK Lung Cancer Screening trial were analysed. Multivariable logistic regression models were used to identify independent...

Rationale: Lung cancer screening has the potential to save lives, but it also carries a risk of potential harms. Explaining the benefits and harms of screening in a way that is balanced and comprehensible to individuals with various levels of education is essential. Although a shared decision-making approach is mandated by the Centers for Medicare...

Pulmonary nodules are frequently detected during clinical practice and require a structured approach in their management in order to identify early lung cancers and avoid harm from over investigation. The article reviews the 2015 British Thoracic Society guidelines for the management of pulmonary nodules and the evidence behind them.

Purpose: Prophylactic irradiation to the chest wall after diagnostic or therapeutic procedures in patients with malignant pleural mesothelioma (MPM) has been a widespread practice across Europe, although the efficacy of this treatment is uncertain. In this study, we aimed to determine the efficacy of prophylactic radiotherapy in reducing the incid...

Introduction Lung cancer is a common cancer, with over 1.3 million cases worldwide each year. Early diagnosis using computed tomography (CT) screening has been shown to reduce mortality but also detect non-malignant nodules that require follow-up scanning or alternative methods of investigation. Practical and accurate tools that can predict the pro...

Background A minority of European countries have participated in international comparisons with high level data on lung cancer. However, the nature and extent of data collection across the continent is simply unknown, and without accurate data collection it is not possible to compare practice and set benchmarks to which lung cancer services can asp...

Introduction: The European Respiratory Society taskforce for harmonised standards for lung cancer registration and lung cancer services in Europe recognised the need to create a single dataset for use in pan-European data collection, and a manual of standards for European lung cancer services. Methods: Existing national and international dataset...

Background: Thirty-day mortality after treatment for lung cancer is a measure of unsuccessful outcome and where treatment should have been avoided. Guidelines recommend offering chemotherapy to individuals with small-cell lung cancer (SCLC) who have poorer performance status (PS) because of its high initial response rate. However, this comes with...

Lung cancer is the most common cause of cancer death in the UK, and survival from the disease is persistently poor. Efforts to improve outcomes for patients have focused on ways of reducing late diagnosis of the disease, and access to optimal treatment. Research on lung cancer screening has so far provided some evidence of an impact on lung cancer...

The European Position Statement (EUPS) expert group comprised of individuals who have been actively involved in the planning and execution of all the low dose CT (LDCT) randomised controlled European screening trials. They have argued that as lung cancer screening with LDCT saves lives, planning for implementation needs to be started by the nationa...

Introduction The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for the investigation and management of pulmonary nodules in the UK, together with measurable markers of good practice. Methods Development of British...

Historically, the prognosis for individuals diagnosed with lung cancer has been bleak. However, the past 10 years have seen important advances in treatment and diagnosis which have translated into the first improvements seen in lung cancer survival. This review highlights the major advances in treatments with curative intent, systemic targeted ther...

Introduction Lung cancer outcomes in England are inferior to comparable countries. Patient or disease characteristics, healthcare-seeking behaviour, diagnostic pathways, and oncology service provision may contribute. We aimed to quantify associations between geographic variations in treatment and survival of patients in England. Methods We retriev...