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BMC Cancer
Published in: BMC Cancer 1/2015

Open Access 01-12-2015 | Research article

The effect of direct access to CT scan in early lung cancer detection: an unblinded, cluster-randomised trial

Authors: Louise Mahncke Guldbrandt, Morten Fenger-Grøn, Torben Riis Rasmussen, Finn Rasmussen, Peter Meldgaard, Peter Vedsted

Published in: BMC Cancer | Issue 1/2015

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Abstract

Background

Lower lung cancer survival rates in Britain and Denmark compared with surrounding countries may, in part, be due to late diagnosis. The aim of this study was to evaluate the effect of direct access to low-dose computed tomography (LDCT) from general practice in early lung cancer detection on time to diagnosis and stage at diagnosis.

Methods

We conducted a cluster-randomised, controlled trial including all incident lung cancer patients (in 19-month period) listed with general practice in the municipality of Aarhus (300,000 citizens), Denmark. Randomisation and intervention were applied at general practice level. A total of 266 GPs from 119 general practices. In the study period, 331 lung cancer patients were included. The intervention included direct access to low-dose CT from primary care combined with a 1 h lung cancer update meeting. Indication for LDCT was symptoms or signs that raised the GP’s suspicion of lung cancer, but fell short of satisfying the fast-track referral criteria on red flag’ symptoms.

Results

The intervention did not significantly influence stage at diagnosis and had limited impact on time to diagnosis. However, when correcting for non-compliance, we found that the patients were at higher risk of experiencing a long diagnostic interval if their GPs were in the control group.

Conclusion

Direct low-dose CT from primary care did not statistically significantly decrease time to diagnosis or change stage at diagnosis in lung cancer patients. Case finding with direct access to LDCT may be an alternative to lung cancer screening. Furthermore, a recommendation of low-dose CT screening should consider offering symptomatic, unscreened patients an access to CT directly from primary care.

Trial registration

www.clinicaltrials.gov, registration ID number NCT01527214.
Appendix
Available only for authorised users
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Metadata
Title
The effect of direct access to CT scan in early lung cancer detection: an unblinded, cluster-randomised trial
Authors
Louise Mahncke Guldbrandt
Morten Fenger-Grøn
Torben Riis Rasmussen
Finn Rasmussen
Peter Meldgaard
Peter Vedsted
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2015
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-015-1941-2

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