Adherence to community-based lung cancer screening in the Yorkshire Lung Screening Trial

Lung cancer screening saves lives by detecting cancers early, but continued adherence to screening rounds is required for participants to experience the maximum clinical benefit. Here we describe factors associated with screening adherence in the Yorkshire Lung Screening Trial.

All eligible individuals following baseline (prevalent) screening were invited for a biennial incident screen in a community setting. Participants were contacted by phone (up to two attempts) to arrange an appointment or sent a pre-arranged appointment letter if non-contactable. Characteristics of attenders versus non-attenders were compared using univariate and multivariable models.

Of 6,650 individuals who attended baseline screening, 5,975 were eligible for the second round. The mean age of those eligible was 70.5 years, 45.2 % were female, 31.7 % were from the most socio-economically deprived quintile and 33.9 % reported current smoking at the time of the baseline scan. Of these, 5,184 (86.8 %) attended their second screen and 791 (13.2 %) did not. Factors associated with lower attendance following multivariable analysis were socio-economic deprivation (OR 0.78, 95 % CI 0.60-1.02, most versus least deprived quintile) and current smoking (OR 0.57, 95 % CI 0.48-0.66, current versus previously quit). Sex, age, and ethnicity were not associated with attendance. Attendance was more likely in people who had an indeterminate (OR 2.10, 95 % CI 1.61-2.73; n = 871) or positive (OR 3.16, 95 % CI 0.98-10.19; n = 60) baseline scan compared to a negative baseline scan.

Adherence was good overall but lower adherence amongst people who currently smoke and those from deprived populations is a concern due to their greater risk of lung cancer death. Further research is needed into interventions that increase adherence in these high-risk populations.