I'm going to start because you're all probably waiting to get your first drink of the day in. We started this back in 2010 and, thinking 2010, 2011 we actually did it, and it came out at the same time as the publication of the NLST, Crisberg may just remember that. And basically that changed our whole life in lung cancer. We have had a workshop now, every year, and hopefully you're going to get a review. Ooh, yes, something's loading, jolly good. Okay, I'm going to try and go through this reasonably quickly because I appreciate the clock is ticking and there's other things that are happening. Which button do I use? Okay, excellent. Okay, so you've already had four excellent overviews, so I'm going to actually take what I think are the high points, but actually I'm going to ask a question. What have we achieved in the workshop since 2011? What new topics should be included up to 2030? Because there is a tendency that there are certain things that we are actually really interested in, but actually what are the main questions? Now this was the publication, in fact Stephen Inlam and I drove this through ISLAC and lots of colleagues participate and it was when he published this year. But this was our five-year plan, but I think we need to adapt it and I'm going to come to that. Okay, this was today. Implementation challenges and successes. Difference in expectation in the clinical trial data and implementation data. I think that is something, you know, we run a trial and then we hope it's actually going to work when we put it out in the practice and it doesn't always. Asia, comparison with UK. The question is the reliability of lung cancer mortality data based on cohort data. We could probably spend all day debating that, but I do question the assumptions and let's say the way forward in that. Current status in Japan. They were the first to start lung cancer screening and they actually should be congratulated for that. But in fact, unfortunately, we're still at the discussion stage and they're still only looking at heavy smokers and they've just begun. Implement challenges. You could say Brexit, we've left Europe, but I still feel part of Europe because I'm Irish and there's a whole list of people that want to be involved. But actually, when it comes down to it, there's actually just starting might be the way I would phrase it. And the countries that say they're doing it, actually, have they really put the finance aside to have a long-term national program? And actually, I would put a question mark over that. Have the sufficient information to sit in front of the Minister of Health and say, we can demonstrate to you the economic benefit of introducing lung cancer screening. And I have a feeling most countries would have that problem. USA, implementation depends on funding availability. Now, I don't want to get into politics here, but I will. Healthcare is a business and if it pays, great, if it doesn't, well, unfortunately, it doesn't happen that well. Maybe change is imminent. I'll leave it there. Okay. Recruitment integration of mobiles. I think that was a great session. The nuts and bolts, really good discussion, and I really liked the unexpected findings. It's the first time, one sees necklaces and one sees brooches, but it's the first time I've ever seen cigarettes as the evidence for lung cancer. Extremely impressive the way they've set it up. Recruitment integration of mobiles, major issue in Australia, I mean, it's all to do with space. But I was impressed by their largest mobile ever built. But there is a remote problem and it's quite clear the remote regions are actually the leading cause in lung cancer. And how does one resolve that? And I know they're working on it, but it's a long-term problem. Recruitment integration in the UK, yes, we can say we're very proud of what's happening. And Manchester did start the whole revolution around mobile units. And targeted lung health check, we are all extremely pleased. I always put an if into this. We're extremely pleased we have around 50% that participate. But you could rephrase that and say 50% don't participate. And I think that's our next challenge in the UK of how we bring that group, because unfortunately that group is a lower socioeconomic. We only had one cartoon in this whole morning and I thought I had to include it. And if you're an Irishman, you might say it was his view of screening, but I won't. I'm Irish, I can get away with that. Okay. I thought the most amazing mobile unit was shown today. And in Brazil, I think Ricardo has actually done an excellent job. I remember him coming to one of our very first CT screening workshops. And there are major financial efforts, they have an enormous country, but they are actually starting to do it. And it's great to see it's going forward. Socioeconomic and quality. This is the first time this has actually been discussed. And unfortunately, it's the first time it's been discussed. The First Nations people discussion was excellent and it pointed out something that, you know, we might talk about socioeconomic in the UK, but the Maori lung cancer incidence rates in the 55 to 59 are much higher than what you'd expect in the normal population. The LGBTQI population, the disparities were made quite clear. And also how one might, let's say, overcome these and encourage participation. And I really enjoyed the community outreach in the USA. Lung Cancer Policy Network. I think Helena and her group have done an enormous job to bring an international group together. I'm part of the steering committee, so I can sort of say I've seen what's happening. But they need to be congratulated because the map I've included is from one of their recent reports about the number of countries across the world that have representatives, but also the funding they've brought in. There's a small list here. And I think it's actually how we share best practice, and we are beginning to think very much more about low and middle income countries, what they can afford, what type of processes is even feasible. I really liked Ray's comment. It's not a science problem. It's a political problem. And I think that is a saying that will stick in the back of my mind for this meeting. Equity in lung cancer screening. I was very pleased this was in, not because it was our publication, but because it was our publication. And the thing is that how often can one turn around and say individuals, lower socioeconomic group, actually gain from screening? And yes, they do. And if you look at this, we published it very, very recently, that the lower socioeconomic group, if I've got it at least, most deprived gain over the CT group, lower, don't get CT. Yes, we measured an IMD, and the upper group also gain, but not as, let's say, eloquently. So we can demonstrate that people who participate, and we also have shown that in fact the whole instance of COPD went down in that particular group, but that's a different discussion. Future directions in emerging technologies. I must congratulate Martin. He had to battle through this with a number of his colleagues. It's a pretty dry subject, but we do need to be able to actually say the difference between chickens and hens. And the thing is that we are in a process that we actually use different language, and if we use different language when we're publishing, then where do we stand? Excellent publication. Well done, Martin. AI, chest x-ray. David's already commented on this, about the pros and cons of it. Is it the way forward? Should we be considering it? I think there is great potential. I think there's great potential, certainly for low-income countries that can't really look at the cost of CT screening, but it does need to be validated, and possibly some form of trial. But I don't want to stick my head out too far on that one. Future direction in emerging technologies. I mean, this is sort of, some of it's a blue sky, but it's actually what a lot of us want to be involved in and want to actually see succeed. The CT biomarkers, the two words, the take-home message, reproducibility, open access. So much of this is in black boxes, and people actually, one, won't share the data, and certainly won't share the mechanism by which they got that result. Biomarkers and lung cancer screening, non-imaging. Excellent session, and I would have preferred if you'd been given half an hour, because I would have loved to have heard his views on multi-cancer tests. I think it is something that is coming to hit us, as a geneticist, as I started life, I think it's wonderful. As a clinician, I actually have great reservations. I should leave it there. There are still challenges, which we haven't covered. Maximizing uptake in the U.K., I've mentioned, maximizing incidental findings, we haven't discussed today. Desperate, I use the word desperate, but the word is desperate, IT systems. Even in the U.K., we have something that is, well, you put the best thing forward, but there isn't a national one. And CT's capacity, and also adequate support for national rollout, and we haven't really mentioned smoking cessation. So I actually think we need to look at our roadmap for 2030. Martin has done us a favor of implementation around recommended screening quality indicators. That now just needs to be implemented. But recommendations for incidental detected lung nodules is still working its way through. The socioeconomic part has now been mentioned. We need to realize it and move with it. Concentrated effort to test and integrate biomarkers into lung cancer screening. We need to think about this seriously for the future. And we need evidence to support cost effectiveness of the identifying additional findings. Yes, we want to undertake calcium scoring. We want to take COPD seriously, maybe it's spirometry, maybe it's by radiology. But are these approaches cost effective? Because to implement them, we need to prove it. Integration of artificial intelligence is, again, something I'm interested in, and there's an enormous discussion around, there's a lot of money being invested, but we do need to move this forward. And I think as a workshop, we need to be taking this on board. Personalizing CT screening interval, do we really? We're going to go into 20 years of screening in the future, does somebody need to be screened every year? Can we use their risk score, can we use their previous CTs to actually change that regularity? And what I've put in purple is that we are ignoring individuals who develop lung cancer who are never smokers. Yes, one might say it's going to be far too expensive a trial, but we need to think about innovative ways of how this is taken forward. And I know within this meeting, we're going to have a discussion on this, but we can't ignore it. And I've pushed it forward to 28, 29, because I know it'll take that length, but we do need to think of how we have a global, not just one country, a global approach, using multiple ways of identifying risk, be it through biomarkers, by family history, et cetera, for individuals to be tested. And I feel that is one of our major issues we still have not addressed. Thank you very much.

lung cancer screening

NLST impact

socioeconomic factors

AI in healthcare

global health strategy