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Article ; Online: Interpreting diagnostic accuracy studies based on retrospective routinely collected data.

Bradley, Stephen H / Shinkins, Bethany / Abel, Gary / Callister, Matthew E J

2024 , Page(s) 111359

Language	English
Publishing date	2024-04-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	639306-8
ISSN	1878-5921 ; 0895-4356
ISSN (online)	1878-5921
ISSN	0895-4356
DOI	10.1016/j.jclinepi.2024.111359
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Article ; Online: Optimising eligibility criteria for lung cancer screening.

Crosbie, Philip A J / Callister, Matthew E J

The Lancet. Respiratory medicine

2023 Volume 11, Issue 8, Page(s) 665–666

MeSH term(s)	Humans ; Lung Neoplasms/diagnosis ; Early Detection of Cancer ; Smoking ; Mass Screening ; Eligibility Determination
Language	English
Publishing date	2023-04-05
Publishing country	England
Document type	Journal Article ; Comment
ZDB-ID	2686754-0
ISSN	2213-2619 ; 2213-2600
ISSN (online)	2213-2619
ISSN	2213-2600
DOI	10.1016/S2213-2600(23)00083-8
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Zs.A 7041: Show issues

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Article ; Online: Lung cancer screening in never-smokers: a balancing act.

Callister, Matthew E J / de Koning, Harry J

The Lancet. Respiratory medicine

2023 Volume 12, Issue 2, Page(s) 93–94

MeSH term(s)	Humans ; Lung Neoplasms/diagnosis ; Smokers ; Early Detection of Cancer ; Smoking ; Mass Screening ; Risk Factors
Language	English
Publishing date	2023-11-29
Publishing country	England
Document type	Journal Article
ZDB-ID	2686754-0
ISSN	2213-2619 ; 2213-2600
ISSN (online)	2213-2619
ISSN	2213-2600
DOI	10.1016/S2213-2600(23)00378-8
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Article ; Online: Early-stage lung cancer associated with higher frequency of chest x-ray up to three years prior to diagnosis.

Bradley, Stephen H / Kennedy, Martyn P T / Callister, Matthew E J

Primary health care research & development

2022 Volume 23, Page(s) e66

Abstract: Objectives: Symptom awareness campaigns have contributed to improved early detection of lung cancer. Previous research suggests that this may have been achieved partly by diagnosing lung cancer in those who were not experiencing symptoms of their cancer. ...

Abstract	Objectives: Symptom awareness campaigns have contributed to improved early detection of lung cancer. Previous research suggests that this may have been achieved partly by diagnosing lung cancer in those who were not experiencing symptoms of their cancer. This study aimed to explore the relationship between frequency of chest x-ray in the three years prior to diagnosis and stage at diagnosis. Settings: Lung cancer service in a UK teaching hospital. Participants: Patients diagnosed with lung cancer between 2010 and 2013 were identified. The number of chest x-rays for each patient in the three years prior to diagnosis was recorded. Statistical analysis of chest x-ray frequency comparing patients with early- and late-stage disease was performed. Results: One-thousand seven-hundred fifty patients were included - 589 (33.7%) with stage I/II and 1,161 (66.3%) with stage III/IV disease. All patients had at least one chest x-ray in the six months prior to diagnosis. Those with early-stage disease had more chest x-rays in this period (1.32 vs 1.15 radiographs per patient, Conclusions: Increased rates of chest x-ray are likely to contribute to earlier detection. Given the known symptom lead time many patients diagnosed through chest x-ray may not have been experiencing symptoms caused by their cancer. The number of chest x-rays performed could reflect patient and/or clinician behaviours in response to symptoms.
MeSH term(s)	Humans ; X-Rays ; Lung ; Lung Neoplasms/diagnosis
Language	English
Publishing date	2022-11-02
Publishing country	England
Document type	Journal Article
ZDB-ID	2027892-5
ISSN	1477-1128 ; 1477-1128
ISSN (online)	1477-1128
ISSN	1477-1128
DOI	10.1017/S1463423622000573
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Article ; Online: Overdiagnosis in lung cancer screening.

Callister, Matthew E J / Sasieni, Peter / Robbins, Hilary A

The Lancet. Respiratory medicine

2021 Volume 9, Issue 1, Page(s) 7–9

MeSH term(s)	Aged ; Aged, 80 and over ; Early Detection of Cancer/adverse effects ; Early Detection of Cancer/psychology ; Humans ; Lung Neoplasms/diagnosis ; Lung Neoplasms/mortality ; Medical Overuse/prevention & control ; Medical Overuse/statistics & numerical data
Language	English
Publishing date	2021-01-06
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2686754-0
ISSN	2213-2619 ; 2213-2600
ISSN (online)	2213-2619
ISSN	2213-2600
DOI	10.1016/S2213-2600(20)30553-1
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Article ; Online: Pre-diagnostic prescribing patterns in dyspnoea patients with as-yet-undiagnosed lung cancer: A longitudinal study of linked primary care and cancer registry data.

Wickramasinghe, Bethany / Renzi, Cristina / Barclay, Matthew / Callister, Matthew E J / Rafiq, Meena / Lyratzopoulos, Georgios

Cancer epidemiology

2023 Volume 86, Page(s) 102429

Abstract: Introduction: Patients with as-yet undiagnosed lung cancer (LC) can present to primary care with non-specific symptoms such as dyspnoea, often in the context of pre-existing chronic obstructive pulmonary disease (COPD). Related medication prescriptions ... ...

Abstract	Introduction: Patients with as-yet undiagnosed lung cancer (LC) can present to primary care with non-specific symptoms such as dyspnoea, often in the context of pre-existing chronic obstructive pulmonary disease (COPD). Related medication prescriptions pre-diagnosis might represent opportunities for earlier diagnosis, but UK evidence is limited. Consequently, we explored prescribing patterns of relevant medications in patients who presented with dyspnoea in primary care and were subsequently diagnosed with LC. Method: Linked primary care (Clinical Practice Research Datalink) and National Cancer Registry data were used to identify 5434 patients with incident LC within a year of a dyspnoea presentation in primary care between 2006 and 2016. Primary care prescriptions relevant to dyspnoea management were examined: antibiotics, inhaled medications, oral steroids, and opioid analgesics. Poisson regression models estimated monthly prescribing rates during the year pre-diagnosis. Variation by COPD status (52 % pre-existing, 36 % COPD-free, 12 % new-onset) was examined. Inflection points were identified indicating when prescribing rates changed from the background rate. Results: 63 % of patients received 1 or more relevant prescriptions 1-12 months pre-diagnosis. Pre-existing COPD patients were most prescribed inhaled medications. COPD-free and new-onset COPD patients were most prescribed antibiotics. Most patients received 2 or more relevant prescriptions. Monthly prescribing rates of all medications increased towards time of diagnosis in all patient groups and were highest in pre-existing COPD patients. Increases in prescribing activity were observed earliest in pre-existing COPD patients 5 months pre-diagnosis for inhaled medications, antibiotics, and steroids, CONCLUSION: Results indicate that a diagnostic window of appreciable length exists for potential earlier LC diagnosis in some patients. Lung cancer diagnosis may be delayed if early symptoms are misattributed to COPD or other benign conditions.
MeSH term(s)	Humans ; Anti-Bacterial Agents/therapeutic use ; Dyspnea/diagnosis ; Dyspnea/drug therapy ; Dyspnea/etiology ; Longitudinal Studies ; Lung Neoplasms/complications ; Lung Neoplasms/diagnosis ; Lung Neoplasms/drug therapy ; Practice Patterns, Physicians' ; Primary Health Care ; Pulmonary Disease, Chronic Obstructive/complications ; Pulmonary Disease, Chronic Obstructive/diagnosis ; Pulmonary Disease, Chronic Obstructive/drug therapy ; Routinely Collected Health Data ; Steroids/therapeutic use
Chemical Substances	Anti-Bacterial Agents ; Steroids
Language	English
Publishing date	2023-07-19
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2508729-0
ISSN	1877-783X ; 1877-7821
ISSN (online)	1877-783X
ISSN	1877-7821
DOI	10.1016/j.canep.2023.102429
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Zs.A 1427: Show issues

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Article ; Online: The Role of Smoking Status in Making Risk-Informed Diagnostic Decisions in the Lung Cancer Pathway: A Qualitative Study of Health Care Professionals and Patients.

Black, Georgia B / Janes, Sam M / Callister, Matthew E J / van Os, Sandra / Whitaker, Katriina L / Quaife, Samantha L

Medical decision making : an international journal of the Society for Medical Decision Making

2024 Volume 44, Issue 2, Page(s) 152–162

Abstract: Background: Lung cancer clinical guidelines and risk tools often rely on smoking history as a significant risk factor. However, never-smokers make up 14% of the lung cancer population, and this proportion is rising. Consequently, they are often ... ...

Abstract	Background: Lung cancer clinical guidelines and risk tools often rely on smoking history as a significant risk factor. However, never-smokers make up 14% of the lung cancer population, and this proportion is rising. Consequently, they are often perceived as low-risk and may experience diagnostic delays. This study aimed to explore how clinicians make risk-informed diagnostic decisions for never-smokers. Methods: Qualitative interviews were conducted with 10 lung cancer diagnosticians, supported by data from interviews with 20 never-smoker lung cancer patients. The data were analyzed using a framework analysis based on the Model of Pathways to Treatment framework and data-driven interpretations. Results: Participants described 3 main strategies for making risk-informed decisions incorporating smoking status: guidelines, heuristics, and potential harms. Clinicians supplemented guidelines with their own heuristics for never-smokers, such as using higher thresholds for chest X-ray. Decisions were easier for patients with high-risk symptoms such as hemoptysis. Clinicians worried about overinvestigating never-smoker patients, particularly in terms of physical and psychological harms from invasive procedures or radiation. To minimize unnecessary anxiety about lung cancer risk, clinicians made efforts to downplay this. Conversely, some patients found that this caused process harms such as delays and miscommunications. Conclusion: Improved guidance and methods of risk differentiation for never-smokers are needed to avoid diagnostic delays, overreassurance, and clinical pessimism. This requires an improved evidence base and initiatives to increase awareness among clinicians of the incidence of lung cancer in never-smokers. As the proportion of never-smoker patients increases, this issue will become more urgent. Highlights: Smoking status is the most common risk factor used by clinicians to guide decision making, and guidelines often focus on this factor.Some clinicians also use their own heuristics for never-smokers, and this becomes particularly relevant for patients with lower risk symptoms.Clinicians are also concerned about the potential harms and risks associated with deploying resources on diagnostics for never-smokers.Some patients find it difficult to decide whether or not to go ahead with certain procedures due to efforts made by clinicians to downplay the risk of lung cancer.Overall, the study highlights the complex interplay between smoking history, clinical decision making, and patient anxiety in the context of lung cancer diagnosis and treatment.
MeSH term(s)	Humans ; Lung Neoplasms/diagnosis ; Smoking/adverse effects ; Smoking/epidemiology ; Risk Factors ; Health Personnel
Language	English
Publishing date	2024-01-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	604497-9
ISSN	1552-681X ; 0272-989X
ISSN (online)	1552-681X
ISSN	0272-989X
DOI	10.1177/0272989X231220954
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Zs.A 1665: Show issues

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Article ; Online: An evaluation of CT radiation doses within the Yorkshire Lung Screening Trial.

Iball, Gareth R / Beeching, Charlotte E / Gabe, Rhian / Tam, Hui Zhen / Darby, Michael / Crosbie, Philip A J / Callister, Matthew E J

The British journal of radiology

2024 Volume 97, Issue 1154, Page(s) 469–476

Abstract: Objectives: To evaluate radiation doses for all low-dose CT scans performed during the first year of a lung screening trial.: Methods: For all lung screening scans that were performed using a CT protocol that delivered image quality meeting the RSNA ... ...

Abstract	Objectives: To evaluate radiation doses for all low-dose CT scans performed during the first year of a lung screening trial. Methods: For all lung screening scans that were performed using a CT protocol that delivered image quality meeting the RSNA QIBA criteria, radiation dose metrics, participant height, weight, gender, and age were recorded. Values of volume CT dose index (CTDIvol) and dose length product (DLP) were evaluated as a function of weight in order to assess the performance of the scan protocol across the participant cohort. Calculated effective doses were used to establish the additional lifetime attributable cancer risks arising from trial scans. Results: Median values of CTDIvol, DLP, and effective dose (IQR) from the 3521 scans were 1.1 mGy (0.70), 42.4 mGycm (24.9), and 1.15 mSv (0.67), whilst for 60-80kg participants the values were 1.0 mGy (0.30), 35.8 mGycm (11.4), and 0.97 mSv (0.31). A statistically significant correlation between CTDIvol and weight was identified for males (r = 0.9123, P < .001) and females (r = 0.9052, P < .001), however, the effect of gender on CTDIvol was not statistically significant (P = .2328) despite notable differences existing at the extremes of the weight range. The additional lifetime attributable cancer risks from a single scan were in the range 0.001%-0.006%. Conclusions: Low radiation doses can be achieved across a typical lung screening cohort using scan protocols that have been shown to deliver high levels of image quality. The observed dose levels may be considered as typical values for lung screening scans on similar types of scanners for an equivalent participant cohort. Advances in knowledge: Presentation of typical radiation dose levels for CT lung screening examinations in a large UK trial. Effective radiation doses can be of the order of 1 mSv for standard sized participants. Lifetime attributable cancer risks resulting from a single low-dose CT scan did not exceed 0.006%.
MeSH term(s)	Female ; Humans ; Male ; Lung/diagnostic imaging ; Lung Neoplasms/diagnostic imaging ; Radiation Dosage ; Thorax ; Tomography, X-Ray Computed/methods ; Clinical Trials as Topic
Language	English
Publishing date	2024-02-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2982-8
ISSN	1748-880X ; 0007-1285
ISSN (online)	1748-880X
ISSN	0007-1285
DOI	10.1093/bjr/tqad045
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Article ; Online: Guideline concordance for timely chest imaging after new presentations of dyspnoea or haemoptysis in primary care: a retrospective cohort study.

Koo, Minjoung Monica / Mounce, Luke T A / Rafiq, Meena / Callister, Matthew E J / Singh, Hardeep / Abel, Gary A / Lyratzopoulos, Georgios

Thorax

2024 Volume 79, Issue 3, Page(s) 236–244

Abstract: Background: Guidelines recommend urgent chest X-ray for newly presenting dyspnoea or haemoptysis but there is little evidence about their implementation.: Methods: We analysed linked primary care and hospital imaging data for patients aged 30+ years ... ...

Abstract	Background: Guidelines recommend urgent chest X-ray for newly presenting dyspnoea or haemoptysis but there is little evidence about their implementation. Methods: We analysed linked primary care and hospital imaging data for patients aged 30+ years newly presenting with dyspnoea or haemoptysis in primary care during April 2012 to March 2017. We examined guideline-concordant management, defined as General Practitioner-ordered chest X-ray/CT carried out within 2 weeks of symptomatic presentation, and variation by sociodemographic characteristic and relevant medical history using logistic regression. Additionally, among patients diagnosed with cancer we described time to diagnosis, diagnostic route and stage at diagnosis by guideline-concordant status. Results: In total, 22 560/162 161 (13.9%) patients with dyspnoea and 4022/8120 (49.5%) patients with haemoptysis received guideline-concordant imaging within the recommended 2-week period. Patients with recent chest imaging pre-presentation were much less likely to receive imaging (adjusted OR 0.16, 95% CI 0.14-0.18 for dyspnoea, and adjusted OR 0.09, 95% CI 0.06-0.11 for haemoptysis). History of chronic obstructive pulmonary disease/asthma was also associated with lower odds of guideline concordance (dyspnoea: OR 0.234, 95% CI 0.225-0.242 and haemoptysis: 0.88, 0.79-0.97). Guideline-concordant imaging was lower among dyspnoea presenters with prior heart failure; current or ex-smokers; and those in more socioeconomically disadvantaged groups.The likelihood of lung cancer diagnosis within 12 months was greater among the guideline-concordant imaging group (dyspnoea: 1.1% vs 0.6%; haemoptysis: 3.5% vs 2.7%). Conclusion: The likelihood of receiving urgent imaging concords with the risk of subsequent cancer diagnosis. Nevertheless, large proportions of dyspnoea and haemoptysis presenters do not receive prompt chest imaging despite being eligible, indicating opportunities for earlier lung cancer diagnosis.
MeSH term(s)	Humans ; Hemoptysis/diagnostic imaging ; Hemoptysis/etiology ; Retrospective Studies ; Lung Neoplasms/diagnosis ; Lung Neoplasms/diagnostic imaging ; Dyspnea/diagnostic imaging ; Dyspnea/etiology ; Primary Health Care
Language	English
Publishing date	2024-02-15
Publishing country	England
Document type	Journal Article
ZDB-ID	204353-1
ISSN	1468-3296 ; 0040-6376
ISSN (online)	1468-3296
ISSN	0040-6376
DOI	10.1136/thorax-2022-219509
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Article ; Online: Evaluating multi-cancer early detection tests: an argument for the outcome of recurrence-updated stage.

Callister, Matthew E J / Crosbie, Emma J / Crosbie, Philip A J / Robbins, Hilary A

British journal of cancer

2023 Volume 129, Issue 8, Page(s) 1209–1211

Abstract: The advent of multi-cancer early detection (MCED) tests has the potential to revolutionise the diagnosis of cancer, improving patient outcomes through early diagnosis and increased use of curative therapies. The ongoing NHS-Galleri trial is evaluating an ...

Abstract	The advent of multi-cancer early detection (MCED) tests has the potential to revolutionise the diagnosis of cancer, improving patient outcomes through early diagnosis and increased use of curative therapies. The ongoing NHS-Galleri trial is evaluating an MCED test developed by GRAIL, and is using as its primary endpoint the absolute incidence of late-stage cancer. Proponents of this outcome argue that if the test reduces the number of patients with advanced, incurable cancer, it can be reasonably assumed to be benefitting patients by reducing cancer mortality. Here, we argue that this assumption may not always hold due to the phenomenon of micro-metastatic disease, and propose an adjustment to the trial outcome so that it may better reflect the expected effect of the test on cancer mortality.
MeSH term(s)	Humans ; Early Detection of Cancer ; Neoplasms/diagnosis ; Neoplasms/therapy ; Neoplasms, Second Primary
Language	English
Publishing date	2023-09-19
Publishing country	England
Document type	Journal Article ; Review ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	80075-2
ISSN	1532-1827 ; 0007-0920
ISSN (online)	1532-1827
ISSN	0007-0920
DOI	10.1038/s41416-023-02434-4
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