the invite. Right, so I have 10 minutes to tell you about the UK experience and I've been asked to focus on the mobile aspect of this. So I often get asked, the UK is a small country, why do you need these trucks to go around? So hopefully over the next 10 minutes I'll show you A, what we've been doing, but also why the mobile aspect of it has been an important bit of our success. So when I thought about how to do this, I thought I would do a bit of a timeline of what's been happening in the UK from a lung cancer screening point of view and throw in some sort of developments as we go along. So like anywhere, it started with NLST, I don't need to tell this audience about it, but this was published, it made headlines but really in Europe not much happened, the US picked it up, but we were kind of waiting for Nelson, that was the messaging. Not long after we did have some stuff happening in the UK, so we had a UKLS trial coming from Liverpool and Cambridge, so not looking at mortality reduction, but it did show in the UK setting that you can do screening, not mobile screening in this aspect, but again some encouragement for us that you can do screening, people will come and you'll find a good amount of cancers and hopefully cure some people. But really that led to the enthusiasm in 2016 to 2018 in the UK, there's a bunch of lung cancer specialists, enthusiasts for screening thinking we should do something about this. So that's where the Manchester Lung Health Checks came in, a programme that I'm involved in, a group in London, Lung Screen Uptake Trial. Some of you will have seen me do these slides, but this is kind of representative of a lot of parts of the UK. Now international audience we should do a bit of a geography lesson, so this is where Manchester is, people have asked me is it in London, it's not in London, people have asked me is it in Scotland because of my accent, it's not in Scotland, it's North West England. But the point I want to make here is the UK is a small island, it's a very densely packed island, we have almost 70 million people now, so bigger population than Australia, Canada, etc. But actually geography isn't the big problem, it's deprivation and sort of social dynamics. So again just reflecting on Manchester, at the time we had the highest incidence of cancer, biggest cause of premature death, and this reflects many cities in the UK, it's not specific to Manchester. So we had a thought about this and one of the key things we wanted to reach that hadn't been done in the studies is this so-called hard to reach. So the people I see in clinic are older, active smokers or certainly heavy smoking history, more deprived backgrounds, and there is data out there, when we started there was data, people were telling us, travel, cost, distance, these are the reasons people can't go even two miles to their local hospital. And there's emotional barriers, we don't like hospitals, we don't like doctors, we don't want to know this. So really we wanted to focus on that. And I guess my advice, like Melissa said, is do your homework and start somewhere. So we did, before we went live, we did some qualitative research, interviews, surveys, some colleagues of mine, really asking our patients and advocates and families if we wanted to do some screening, what should we do, how should we work? And again, a lot of data has come out in the last 10 years about this kind of stuff, but the messaging was clear, I'm not going to go through all this stuff, a lot of you will have seen this, but for the purpose of this talk in terms of why mobile scanners, the message was very clear, I don't like hospitals, I don't want to come, I don't want to see doctors, I don't want to travel, even if it's two miles down the road, that's not where I want to go, I don't have time, it needs to be convenient. So if you want people to come and have screening, we need to make it convenient. And that's where the idea of the mobile scanners came from. So this was us in 2016 in Manchester, begging and pleading for any sort of mobile truck that we can get, this was a standard mobile CT scanner that we can get access to in the NHS, three pilot sites. I like these pictures that I took because it shows you the summer of Manchester, that's one of our hottest days. But the point is, I think there's an often misconception about the lung health check trucks, people think we just turn up to car parks, open the door and sort of shout come on and have a scan. Not quite that simple. A lot of thinking goes into this, so we have a whole team that strategically decide where the truck should go, where and why, we use primary care data, we kind of do it based on deprivation, smoking rates, etc. The other point I want to make is before we go anywhere, within two, three months, we do a lot of public engagement, we have specific members of the team that will go out there and tell people, look, this is coming, it's not scary, it's good for you, this is why it's helpful. So people do have to book appointments and be ready for it to come. And again, people are probably bored of me saying this, just to go back to the timeline, at the time, we didn't know what we were going to get, but we were very pleased to see, and I'll show you the other city's data in a second, but lots of people came and we found lots of cancer. Lung cancer detection rate 4.4% over two rounds. One cancer for every 23 people screened on these trucks and we're scanning up to 60 people in a day, so huge numbers. But I'm not going to focus on the cancer side, the point is, successful from a screening point of view, but again, some of you that have seen me speak will have seen me present the slide before, did we get the right people to come to these trucks, or was it the worried well? And you can see, you know, the majority in the most deprived segments of our population, most left school without early age, again, markers for lung cancer risk, and I could go on and on, so really high risk populations. The lung screening uptake trial based in London, so not mobile CT screening, but happening around the same time, again, it was an RCT looking at invitation strategies, the negative primary outcome, but actually what captured imagination was, again, people wanted to be screened, lots of cancers found. Now at the time there was a bit of a debate when these started coming out in the UK, do you need mobile scanners, do we not? In the UK, London is very different to other places in terms of public transport, we have the Tube, whoever's been to London, very easy, culturally accepted that you travel around, whereas actually in the rest of the UK, public transport, not as easy, not as good. We did some work in Manchester for us to say, actually, do we need these trucks or not? And you can see for our population, it was an important factor, so we looked at in the first two years people came, they said, yes, this community-based aspect is important to us. One in four said, if you had the exact same programme in your hospital, which is less than two miles down the road, I would not have come. And you can see travel related, logistical things, parking, distance, cost, all the usual things. The Liverpool Healthy Lung Project, another big health check programme happening at the same time, published the data in 2019, again, success, lots of people coming, cancers found, great programme. What was interesting at the time, I don't know if things have changed, John's an audience, he might update us, but at the time, a fundamental difference between the Liverpool programme and Manchester was the health checks, the assessment happened in the community, GP practices or wherever it might be, but if you qualified for a scan, you would get an appointment to say, okay, you need to go to hospital in three days at this time for your scan. And whilst the uptake and so on was brilliant, you could see 15% or so did not attend their scan, so perhaps that mobile aspect for it was important. Because I think you'll find in the programmes where the scan is there with the health check, in our programme, consistently 99.5% of people will have a scan, despite shared decision information, all the caveats they discuss, people, you know, want to participate, and it's convenient, it's there. Now, the point is, I'm going to show you some headlines, so this is a cartoonist, at the time, it kind of caught fire, so you can see lots of news headlines about these health checks, and the point I want to make is, the supermarket aspect of it, I always make the joke that Angela wasn't very impressed, but you can see cancer in supermarket car parks, supermarket car park, shoppers, it was this mobile aspect in the community that was capturing imagination, rather than the science of the cancer screening and finding cancers. So all the headlines were related to the sort of park lots and supermarkets, for the record, it's not always in supermarket car parks, but that's what... And with fame comes money and power, right? So then, all the sort of funders said, this is brilliant, you should do more, here's some more money, please do more of this. So you can see the clouds went away, it became sunny, and everything was great, but we got companies interested, and we've got partners now that help develop these trucks, and the trucks got better. Some of you will have seen me present these slides, so our scanners, you can see one, I don't have a mouse, but the bottom one is three trucks, we try and... Can you do that? Yeah, so it's three trucks, side by side, one, two, three, they're interconnected, the scanner's here, and you come in, and we do a lot of things in the health check, it's not just CT screening, so all these individual rooms, you'll get various health measures, we'll do smoking station, we'll do research, bloods, biomarkers, all sorts of things. And again, I always make the joke, it's like Ikea, for those that have Ikea, once you're in, there's no escape, you have to go all the way to the end before we let you out, so that's how we get you, we just need you through the door. So lots of action in those years in the UK, with these pilots, these proactive programmes, Manchester, London, Liverpool, trying to make things happen. But that success, and that pressure, and that sort of headline grabs, is kind of focused NHS England, so that's kind of more, becoming a little bit more national, so you'll hear this term a lot in coming years, if you haven't already, the NHS England TLHC programme, Targeted Lung Health Check programme, sort of a national programme, not quite. But what was important at the time is, we have this thing called NHS Long Term Plan, essentially a government document that says what we're going to do with healthcare in coming years, and what was really encouraging for us is, they mention the rollout of these mobile units, so suddenly the government was getting hold of this. And that led to a bigger pilot, some more sites, at the same time just some headlines, Mild came out with a 10 year follow-up, positive. We started a Yorkshire Lung Screen trial, Professor Callister in Leeds, again this is his slide, I won't bore you with the details, some of you will know some of this is a big prospective trial looking at various things, the point I want to make is, mobile units, similar design, and again from the data we're seeing and we're going to see more stuff, public like this, it's very convenient, people turn up. I remember being at this conference, waiting for Harry to tell us about Nelson, and actually a lot of the UK audience was quite nervous at that time, because we'd really committed to screening, and I was very pleased it was positive, because we would have had to answer some questions. And really, the last three years, that TLHC programme has got bigger and bigger, so we now have 43 sites, live sites, disappointingly as a Scotsman, all in England, so England, Scotland, Wales, Northern Ireland still catching up, but lots of sites, and this graph is a little bit old, but you can see, month by month, more and more screened, more and more cancer detected. This is the latest data, live data we can get, it's always three months behind, this is current state of play in the UK, so we've invited just under 2 million people, and we've screened just over half a million. The ambition of the national programme is whole population coverage, so all those eligible invited by 2018, and we think we're about a third of the way there, so very ambitious, but making huge, and it's not each site does what they like, there is a national protocol that we should all adhere to. So, we now have a national screening programme, the National Screening Committee has recommended we do screening, and where we're at is just trying to figure out how we gradually phase up and try and cover the population. So thank you very much.

mobile lung cancer screening

geographical accessibility

underserved populations

NHS Targeted Lung Health Check

cancer detection