Earlier diagnosis of lung cancer Dr Neal Navani MA MSc PhD FRCP Consultant Respiratory Physician, UCLH Co-clinical lead, NLCA @LungConsultant

IASLC Stage grouping for TNM 8 Earlier stage improves survival;

Millimeters matter

Olesen et al BJC 2009

Diagnosing lung cancer at earlier stage -1 Engage with primary care Promote Be Clear On Cancer campaign CXR and CT capacity Ironmonger BJC 2015

Diagnosing lung cancer at earlier stage -1 Promote Be Clear On Cancer campaign May to Late August 2017

Diagnosing lung cancer at earlier stage -2 Open access / self-referral for CXR Advertising campaign Community education 55% increase in CXRs in 2011 vs previous years (Callister et al.) Reduced emergency admissions GP direct access to CT Clinical risk assessment tools

Diagnosing lung cancer at earlier stage - 3 Dysplastic airway lesions Severe dysplasia / CIS on airway biopsy or at resection margin Autofluorescence bronchoscopy Surveillance for progression to invasive carcinoma

Diagnosing lung cancer earlier Follow available guidelines Biopsy lymph nodes vs primary Nodule clinics / BTS guideline Fewer scans National optimal lung cancer pathway

Diagnosing lung cancer earlier Lung-BOOST: 132 pts Stage I - IIIA Navani et al Lancet Resp Med 2015

Diagnosing lung cancer earlier Navani et al Lancet Resp Med 2015

Diagnosing lung cancer earlier Co-morbidity management Increase biopsy rate Increase active treatment rates Increase radical treatment rates Reduce decline in PS

Summary

@LungConsultant n.navani@ucl.ac.uk Acknowledgments UCLH Lung cancer MDT UCL Respiratory NLCA team Mat Callister, David Baldwin @LungConsultant n.navani@ucl.ac.uk