Difficulties and challenges in implementing screening for lung cancer in high-risk group patients in the respiratory clinic at Groote Schuur Hospital

Emhemed, Mohamed

Difficulties and challenges in implementing screening for lung cancer in high-risk group patients in the respiratory clinic at Groote Schuur Hospital

Thesis / Dissertation

2025

Abstract

Introduction: Lung cancer is the leading cause of cancer related deaths in South Africa. The high prevalence of cigarette smoking in our population continues to contribute to the high burden of lung cancer. Screening high risk groups with annual low dose computed tomography (LDCT) has demonstrated the potential benefit of being able to identify individuals with early-stage disease and offer potential curative therapy from this deadly disease. Objective: To determine the barriers and challenges of implementing lung cancer screening in a group of high-risk patients with underling Chronic Obstructive Pulmonary Disease (COPD). Methods: We retrospectively analysed patient records of COPD patients attending the respiratory clinic at Groote Schuur Hospital, Cape Town in the year 2022. Eligibility for lung cancer screening included formal diagnosis of COPD, age 55-74 years, at least 30 pack year history of smoking or stopped smoking within the past 15 years, no history of lung cancer, good general health, fitness for surgery and patients' willingness to undergo further invasive investigations and treatment. Fitness for surgery was objectively determined by a modified Medical Research Council (mMRC) score less than 3 and FEV1 greater than one litre. Results: 116 patients with COPD were screened for eligibility for lung cancer screening. The mean (SD) age was 62.84(10.4) years and 56.1% were male. 44 (37.9%) patients were current smokers, 68 (58.6) were ex-smokers and 4 (3.5%) never smoked. Hypertension (46.6%) was the most common medical comorbidity, followed by previous tuberculosis (19.0%) and diabetes (7.8%). 16 (13.8%) patients were potentially eligible for lung cancer screening. 47 patients had a FEV1 < 1L, 54 participants had a mMRC of 3 and above and 38 patients were excluded because of age. Conclusion: Common clinical factors which made patients ineligible for lung cancer screening in our study are age and poor surgical candidates based on mMRC class and low FEV1. Tertiary service severe/multimorbid COPD clinics provide few patients for lung cancer screening, community-based service may provide a better yield of patients for active lung cancer screening.

Keywords

lung cancer

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