This article was first published at healthandcare.scot

Campaigners and clinicians say the Scottish government is moving too slowly on its commitment to introduce lung cancer screening in Scotland despite the number of new patients it could identify and treat sooner – and the significant savings for the NHS that it would bring.

Scotland’s Minister for Public Health has told parliament that it could take up to a decade to implement a full screening programme.

A leading lung cancer charity says, with a national lung screening programme announced for Wales last month and a scheme in England having already diagnosed thousands of new cases – Scotland is being left behind.

In September 2022 the UK Screening Committee recommended the roll out of a lung cancer screening programme across all four nations, targeting those at increased risk of developing the disease. They concluded the evidence supported the use of risk assessment and CT for those aged 55 to 74.

The Scottish government responded to the UK Committee recommendations by establishing a Scottish Expert Advisory Group for lung screening “to provide advice on the scoping, implementation, establishment and delivery of a targeted lung cancer screening programme within Scotland.”

The government says the expert group also took on board the findings of a separate study called LungScot, which completed over a year ago, which examined practical steps needed to introduce low dose CT scanning in Scotland.

However, one of the lead clinicians for that study cautions that, despite the valuable lessons learned, LungScot was “a small pilot that was underfunded and underpowered due to this lack of funding”.

The Scottish government’s 2023 cancer strategy set an ambition of earlier and faster diagnosis, committing ministers to taking forward the national recommendations.

Earlier this summer in its Population Health Framework 2025-2035 the government committed to pilot another lung screening programme.

This month, in response to a series of parliamentary questions from Scottish Liberal Democrat leader Alex Cole-Hamilton MSP, Minister for Public Health, Jenni Minto MSP said ministers acknowledge the value of early diagnosis of lung screening and recognise that evidence shows that lung screening can save lives.

Ms Minto explained that work is now underway to set up a pilot:

‘A pilot will enable us to test a national delivery model, gain deeper insights into effective implementation strategies and explore alternative approaches to boost uptake and participation. It will also enable screening to begin earlier in areas experiencing the highest levels of socio-economic deprivation, as evidence shows these individuals are at higher risk of lung cancer and have higher mortality rates.

‘We will continue collaborating with colleagues across the NHS and partner agencies to ensure the effective rollout of lung screening, while exploring ways to minimise the impact on services further along the treatment pathway.’

She said details of the pilot will be published ‘in due course’.

The lung cancer charity, the Roy Castle Cancer Foundation, which launched its ‘Need to Screen’ campaign in 2022, says it’s hard to understand why another pilot is needed when other UK nations are moving ahead with rollout.

A long time campaigner for the charity, director of information and support, Lorraine Dallas, said:

“It seems the prioritisation and engagement with delivering this change has had a mixed level of focus and priority across our health systems. This is a situation where there has been significant variation in the approaches of the four devolved health bodies.”

In June, the government in Wales committed to a rollout of screening by 2027, while, in England, an established screening programme is already showing results.

The Foundation says, by January 2025, 31% of the eligible population had been assessed and offered screening, 6,200 people had been diagnosed with lung cancer through lung cancer screening, of whom 75% had Stage I or II disease – the stage at which the aim of treatment is cure. This compares, the Foundation says, to 29.2% of patients diagnosed with stage I or II disease in Scotland in 2022. 

The clinician’s perspective

Professor of Clinical Radiology at the University of Edinburgh and Consultant Cardiovascular Radiologist, Edwin van Beek, says lung cancer screening has been brought in successfully in many countries across the world – and the case for it in human and economic terms is overwhelming:

“Not doing anything is not an option, as we continue to see many people dying unnecessarily, while many are also lost as economically important contributors, dying before retirement age.

“It seems that the current response completely overlooks the ongoing costs to Scotland’s NHS of not having  lung cancer screening.

“Scotland today sees about 5,000 new cases of lung cancer per year. Most are diagnosed in stage IV. In Europe, the cost of treating one patient at stage IV is known to be around €90k. The cost to the NHS in the UK will be much the same.

“So where is the actual costs-benefit calculation?”

In her written answers to parliament, the Minister for Public Health says setting up a national programme will cost £36m, with estimates for annual costs of up to £39m

She added that due to the ‘complexities’ of rolling out a national screening programme recognised by both the UK and Scottish expert groups, it will take seven to ten years to fully implement:

Professor van Beek disagrees with that estimate:

“Implementation over a duration of seven to ten years is absolutely unnecessary when we look at how fast other countries have implemented this.

“There is ample experience we can build on.

“We have now been talking about this for nearly a decade, so how much more time do we want to spend talking and not doing anything?”

The Roy Castle Foundation says nobody benefits from delaying implementation:

“Looked at through the lens of the lives that could be saved, the pace of change to implement lung cancer screening has been frustrating,” adds Ms Dallas.

“The charity will keep a focus on implementation and UK wide roll out. The need to embed this change in the diagnostic pathway is an essential part of improving outcomes for one of the UK’s biggest causes of cancer deaths.”