Combining screening for lung and kidney cancers – for both of which smoking is a risk factor – could help identify undiagnosed cases of kidney cancer, say researchers as they release the results from a study showing this approach is feasible and acceptable to participants.
Early detection of cancer allows the best chance of cure using effective treatments such as surgery. The UK has recently approved a screening programme for smokers at greatest risk of lung cancer. The programme makes use of lung computed tomography (CT) scans, which build up a detailed picture of the inside of an individual’s body by taking multiple x-rays.
Certain cancers, however, are relatively rare and standalone screening programmes are unlikely to be cost-effective. One such disease is kidney cancer. Kidney cancer is the ninth commonest cancer in men and 14th in women, and is largely curable if treated at an early stage. But almost nine in ten patients (87%) will have no symptoms at the stage when it is still curable.
As lung and kidney cancers share risk factors, Yorkshire Cancer Research, in partnership with experts at the University of Cambridge, established the Yorkshire Kidney Screening Trial to see whether screening for kidney cancer could take place at the same time as screening for lung cancer. The results are published in European Urology.
“Kidney cancer is curable if we catch it early enough, but it’s a largely silent disease at that stage, making it very difficult to spot.”
Professor Grant Stewart, University of Cambridge, Chief Investigator on the trial
“We know that smokers who are at high risk of lung cancer are also at increased risk of kidney cancer, so it makes sense to see if we can look for both conditions at the same time.”
Abdominal CT scans were offered to 4,019 ‘ever-smokers’ – that is, people who had smoked at some period in their life – aged 55-80 years old who were attending a lung cancer screening trial between May 2021-October 2022.
Of those offered the additional abdominal scan, more than nine in 10 (93%) accepted. Of these, almost two-thirds (64%) were found to have normal abdominal scans. One in five (20%) required an imaging review but no further action. 15% required further investigations at a clinical review.
One in twenty (5.3%) participants had a previously-undetected serious finding only seen on the abdominal CT scans, including kidney and other abdominal cancers, abdominal aortic aneurysms (a swelling in the artery that carries blood from the heart to the abdomen, which can be serious because they risk bursting) and kidney stones.
Professor Stewart added: “We were able to make use of an existing targeted screening study to ‘bolt-on’ an additional screening test. Patients were very receptive to be screened for several conditions, and this approach helped us identify serious findings in one in 20 participants that carried a real prospect of seriously threatening life span, or of having a substantial impact on their lives.”
A concern with any screening programme is the identification of incidental, non-serious lesions that do not require treatment but carry the risks associated with diagnosis and treatment, create unnecessary anxiety for these individuals, and potentially divert healthcare resources away from other conditions.
In the Yorkshire Kidney Screening Trial, a quarter of participants (25%) had non-serious findings. However, because the trials was set up to allow a robust clinical review of the radiological findings and clear lines of communication with associated specialities to determine if further tests or clinics were needed, only a third of these (8.5% of participants) had incidental findings that triggered further action in the form of further clinic appointments or investigations.
A sub-study published separately also showed that those with non-serious findings did not have lasting psychological, social or financial harms.
Speaking on behalf of the trial funder, Dr Stuart Griffiths, Director of Research at Yorkshire Cancer Research said: “People with kidney cancer are often diagnosed at a late stage when treatment options are more limited. Screening people before they experience any symptoms means the kidney cancer can be found at a very early stage – enabling many people to receive life-saving treatment.”
“Adding an abdominal CT to the recently approved lung cancer screening programme provides a vital opportunity to improve early diagnosis and save thousands of lives in Yorkshire and across the UK.”
Dr Stuart Griffiths, Director of Research, Yorkshire Cancer Research
Jenifer Perrin, aged 81, has lived in Otley on the outskirts of Leeds for 50 years. She used to be a sewing machinist at a local factory, where she worked making curtains – a skill she says macular degeneration has sadly put paid to.
In 2019, Mrs Perrin was invited for a CT scan as part of the Yorkshire Lung Screening Trial (YLST) in a mobile unit, which fortunately found no sign of disease. In October 2022, after a follow-up scan as part of YLST, she was offered a kidney screening as part of the Yorkshire Kidney Screening Trial. She had never been ill and had no symptoms, but agreed. This time, however, the scan picked up an abnormality, a small tumour, around 2.5cm in diameter.
“When they said, ‘You’ve got the C’, I just took a deep breath,” she says. “I thought, ‘Well, it is what it is. There’s no point worrying.’”
Following a biopsy to confirm that the tumour was indeed cancerous, Mrs Perrin was referred to Professor Tze Min Wah and offered treatment using high intensity focused ultrasound (HIFU), a minimally-invasive treatment that required her to go under a general anaesthetic, but involved “no needles and no cutting,” she says.
The operation took place on the Thursday before the Coronation of King Charles III and apart from sickness that she puts down to the after-effects of the anaesthetic, she says there were no side-effects.
Following the treatment, she would return to St James’s Hospital every month for a follow-up scan and blood test. In October 2023, she was finally given the all clear.
“I’m really glad I had the chance to take part in the trial,” she says. “I’d never been ill, so without the CT scan, they might not have spotted my cancer early. As it was, they were able to blast it away using ultrasound. I think I was the second person in the world to have this treatment – the first woman in the world to get it. I like telling people that!”
The Yorkshire Kidney Screening Trial was funded by Yorkshire Cancer Research. Additional support was provided by the National Institute for Health and Care Research (NIHR) Cambridge Biomedical Research Centre and Manchester Biomedical Research Centre, and by Kidney Cancer UK.
References
Stewart, GD et al. Abdominal Noncontrast Computed Tomography Scanning to Screen for Kidney Cancer and Other Abdominal Pathology Within Community-based Computed Tomography Screening for Lung Cancer: Results of the Yorkshire Kidney Screening Trial. European Urology; 12 Sept 2024; DOI: 10.1016/j.eururo.2024.08.029
Usher-Smith, JA et al. Short-term psychosocial outcomes of adding a non-contrast abdominal computed tomography (CT) scan to the thoracic CT within lung cancer screening. BJUI; 14 Dec 2023; DOI: 10.1111/bju.16260
Usher-Smith, JA et al. Acceptability of adding a non-contrast abdominal CT scan to screen for kidney cancer and other abdominal pathology within a community-based CT screening programme for lung cancer: A qualitative study. PLOS ONE; 1 Jul 2024; DOI: 10.1371/journal.pone.0300313
Main image
Kidney cancer illustration (SEBASTIAN KAULITZKI/SCIENCE PHOTO LIBRARY)
The text in this work is licensed under a Creative Commons Attribution 4.0 International License
source: cam.ac.uk