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Observational Study
. 2025 May;26(5):609-619.
doi: 10.1016/S1470-2045(25)00082-8. Epub 2025 Mar 25.

Low-dose CT for lung cancer screening in a high-risk population (SUMMIT): a prospective, longitudinal cohort study

Amyn Bhamani  1 , Andrew Creamer  1 , Priyam Verghese  1 , Ruth Prendecki  1 , Carolyn Horst  1 , Sophie Tisi  1 , Helen Hall  1 , Chuen Ryan Khaw  1 , Monica Mullin  2 , John McCabe  1 , Kylie Gyertson  3 , Vicky Bowyer  3 , Dominique Arancon  3 , Jeannie Eng  3 , Fanta Bojang  3 , Claire Levermore  3 , Anne-Marie Hacker  4 , Esther Arthur-Darkwa  4 , Laura Farrelly  4 , Anant Patel  5 , Sara Lock  6 , Alan Shaw  6 , Rajesh Banka  7 , Angshu Bhowmik  8 , Ugo Ekeowa  9 , Zaheer Mangera  10 , Christopher Valerio  10 , William M Ricketts  11 , Ali Mohammed  11 , Terry O'Shaughnessy  11 , Neal Navani  12 , Samantha L Quaife  13 , Arjun Nair  3 , Anand Devaraj  14 ; SUMMIT consortium; Jennifer L Dickson  1 , Allan Hackshaw  4 , Sam M Janes  15
Collaborators, Affiliations
Free article
Observational Study

Low-dose CT for lung cancer screening in a high-risk population (SUMMIT): a prospective, longitudinal cohort study

Amyn Bhamani et al. Lancet Oncol. 2025 May.
Free article

Erratum in

Abstract

Background: Low-dose CT screening reduces lung cancer mortality. In advance of planned national lung cancer screening programmes, research is needed to inform policies regarding implementation. We aimed to assess the implementation of low-dose CT for lung cancer screening in a high-risk population and to validate a multicancer early detection blood test.

Methods: In this prospective, longitudinal cohort study, individuals aged 55-77 years recorded as current smokers in their primary care records at any point within the past 20 years were identified from 329 primary care practices in London (UK) and invited for a lung health check via postal letter. Individuals meeting the 2013 United States Preventive Services Taskforce criteria (current or former smokers within the past 15 years with at least 30 pack-year smoking histories) or having a Prostate, Lung, Colorectal and Ovarian 2012 model 6-year risk of 1·3% or greater, and not currently receiving treatment for an active cancer (except adjuvant hormonal therapy), were eligible for the study. These individuals underwent lung cancer screening via non-contrast, thin collimation low-dose CT. In this analysis, we report the results of the baseline round of low-dose CT screening. Key primary endpoints were those associated with examining the performance of a lung cancer screening service. Outcome measures were analysed on a per-participant level using descriptive frequencies. The study was registered with ClinicalTrials.gov, NCT03934866.

Findings: Between April 8, 2019, and May 14, 2021, 12 773 participants were recruited and analysed. 7353 (57·6%) of 12 773 participants were male and 5420 (42·4%) were female, and 10 665 (83·5%) participants were White. 261 (2·0%) of 12 773 participants were diagnosed with lung cancer (including 163 [1·3%] participants with screen-detected lung cancer and 98 [0·8%] with delayed screen-detected lung cancer [ie, after a 3-month or 6-month nodule follow-up CT]) and 276 (2·2%) participants were diagnosed with any intrathoracic malignancy after a positive baseline screen. 207 (79·3%) of 261 individuals with prevalent screen-detected lung cancer were diagnosed at stage I or II and surgical resection was the primary treatment modality in 201 (77·0%) of 261 individuals. Including cases where multiple resections were done in the same participant (eg, for synchronous primaries), 28 (11·6%) of 241 surgical resections were benign, and there was one (0·4%) death within 90 days of surgery. At 12 months, the episode sensitivity of our low-dose CT screening protocol for detecting lung cancer was 97·0% (95% CI 95·0-99·1; 261 of 269 participants). The specificity was 95·2% (94·8-95·6; 11 905 of 12 504 participants), with a false-positive rate of 4·8% (4·4-5·2).

Interpretation: Large-scale lung cancer screening is effective and can be delivered efficiently to an ethnically and socioeconomically diverse population.

Funding: GRAIL.

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Conflict of interest statement

Declaration of interests AmB, AC, PV, RP, CH, ST, HH, CRK, JM, and JLD were or are employed by University College London through SUMMIT study funding provided by GRAIL. SMJ has received fees for advisory board membership in the last 3 years from Bard1 Lifescience; has received grant income from GRAIL; is an unpaid member of a GRAIL advisory board; and has received lecture fees for academic meetings from Cheisi and Astra Zeneca. SMJ's wife works for AstraZeneca. NN reports honoraria for non-promotional educational talks or advisory boards from Amgen, AstraZeneca, AXANA, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, EQRx, Fujifilm, Guardant Health, Intuitive, Janssen, Lilly, Merck Sharp & Dohme, Olympus, and Roche; has received support for attending meetings or travel from Astra Zeneca, Fujifilm, Intuitive, Merck Sharp & Dohme and Olympus; and is a member of the British Thoracic Oncology Group steering committee, director of the UK Lung Cancer Coalition, and clinical director of the National Lung Cancer Audit. SLQ collaborates on the SUMMIT study; has received an honorarium from Elsevier for writing a book chapter; and has received payment for a presentation/website context piece from the Global Lung Cancer Coalition. AN has received a consultation fee from Merck Sharp & Dohme; received honoraria for speaking engagements from Mevis Medical Solutions; and is an honorary executive committee member of the British Society of Thoracic Imaging, co-chair of the British Thoracic Society Pulmonary Nodule Guideline Development Group, is a Lung Taskforce member for the British Lung Foundation, and clinical lead for the NHS England Targeted Lung Health Checks Programme. AD reports consulting fees from AstraZeneca, Boehringer Ingelheim, and Brainomix; and stock or stock options from Brainomix. AH has received support for travel for an advisory board meeting for Roche; and is on academic scientific advisory boards for Adela Bio, Roche, and Luventix, who are developing multicancer blood or urine tests, but receives no payments or honoraria from any of these companies. MM reports support for travel to an international conference from GRAIL. All other authors declare no competing interests.

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