Christine Campbell

Objectives: To assess the feasibility and acceptability of delivering risk-stratified low-dose CT (LDCT) lung cancer screening across diverse geographical and socioeconomic settings in Scotland and to characterise uptake, participant profile and screening outcomes. Design: Prospective, multicentre pilot feasibility study with descriptive analysis. Setting: Primary and secondary care interface across four regional Health Boards in Scotland, encompassing urban, rural, remote and socioeconomically deprived populations. Participants: 2801 individuals aged 50–74 years, identified from primary care electronic medical records (EMRs), with a history of smoking were invited (current or within 15 years where available); 668 (23.8%) responded. Of 608 assessed for eligibility (50.8% female; median age 63 years), 503 (82.7%) met at least one predefined high-risk criterion. Interventions: Invitation to a lung health check, followed by telephone-based risk assessment using US Preventative Services Task Force, Liverpool Lung Pathway version 2 and the Prostate, Lung, Colorectal and Ovarian Screening Trial criteria. High-risk participants were offered a one-off LDCT scan at local centres. Primary and secondary outcome measures: Primary: feasibility indicators including uptake, risk eligibility and scan completion. Secondary: prevalence of lung cancer, pulmonary nodules and incidental findings (eg, coronary artery disease, emphysema). Results: Response rate was 23.8% (668/2801), varying from 17.8% to 38.1% across practices and lower in more deprived areas. Of 503 eligible participants, 436 (86.7%) underwent LDCT. Abnormal findings were present in 83.3% of scans. Lung nodules were detected in 25.7% (112/436), with 11.8% requiring follow-up. Lung cancer was diagnosed in 1.15% (5/436; 95%), alongside five additional malignancies. Coronary artery disease was identified in 56.4% (246/436) and emphysema in 33% (144/436). Non-responders were more likely to be current smokers (69.3% vs 49.8%). Conclusions: Recruitment of people for lung cancer screening using the smoking history recorded in their primary care EMR is feasible. This approach identifies a high-risk population with a high burden of both malignant and non-malignant disease, and with substantial undiagnosed disease burden. However, uptake was modest and socially patterned, highlighting the need for equity-focused implementation strategies, including repeated invitations and targeted engagement. These findings are particularly relevant as Scotland considers implementation of a national lung cancer screening programme within a health system characterised by marked geographical and socioeconomic inequalities. Further research should evaluate long-term outcomes, cost-effectiveness and strategies to improve equitable participation.

Multimorbidity, the co-existence of two or more long-term conditions, is up to three times more prevalent among people with cancer than in the general population and is associated with poorer survival, particularly for cancers with a more favourable prognosis such as colorectal cancer. In Scotland, multimorbidity is the norm among older adults, emerges earlier in socioeconomically deprived populations, and may contribute to comparatively low cancer survival rates. Despite this, the influence of multimorbidity on the colorectal cancer pathway remains poorly understood. We conducted a Scottish data-linkage study of adults diagnosed with colorectal cancer between 2010 and 2014, linking the Scottish Cancer Registry to national prescribing, hospital admissions, death registration, and bowel screening datasets. Prescribing data were used to derive overall and system-specific comorbidity measures as a proxy for multimorbidity and active disease burden. Associations with stage at diagnosis, treatment, survival, and screening uptake were examined using logistic regression and Cox proportional hazards models adjusted for demographic and clinical covariates. Among 19,043 patients, 87% had at least one prescribing-based comorbidity, most commonly cardiovascular, nervous system, and gastrointestinal conditions. Overall comorbidity burden was not associated with stage at diagnosis, although laxative-related prescribing was associated with later-stage disease. Increasing comorbidity burden reduced the likelihood of receiving any treatment and surgery, while associations varied across system-specific comorbidities. Higher comorbidity burden was also associated with increased all-cause and colorectal cancer-specific mortality, particularly among patients with respiratory, nervous system, and haematological/nutritional conditions. Screening uptake was not associated with overall comorbidity burden but did differ by system-specific comorbidity. Prescribing-based multimorbidity was highly prevalent and strongly associated with treatment patterns and mortality among patients with colorectal cancer. System-specific multimorbidity measures provided greater discrimination than overall morbidity counts, highlighting the importance of considering distinct multimorbidity profiles when assessing cancer pathways and designing targeted interventions for optimising treatment and survival.

Objectives: This study aimed to determine the prevalence of cervical high-risk human papillomavirus (hrHPV) in a community-based setting and its risk factors association in women living in hard-to-reach areas in Bangladesh. Design: A cross-sectional study Setting: The study was carried out in six subdistricts, located in hard-to-reach and climate-impacted regions of Bangladesh. Participants: A total of 8000 married women aged 30–60 years were invited for screening. Women who were unable to give consent, were pregnant or had a hysterectomy with removal of the cervix, previous screening less than 5 years, or treatment of the cervix or had symptoms of potential cervical cancer were excluded. Interventions: A community-based hrHPV self-collected screening for cervical cancer was conducted from June 2022 to July 2023. Main outcome measures: Prevalence of cervical hrHPV and risk factor association. Results: 11 127 women were eligible for screening; 7850 women submitted hrHPV self-swabs, 7828 valid HPV test results were reported and 164 women (2.1%) tested hrHPV positive. Women living in the North were 2.1 times more likely to be hrHPV positive compared with women living in the South (adjusted OR (AOR)=2.1, 95% CI: 1.5 to 3.8, p=0.023) and widowed women were 3.0 times more likely to be hrHPV positive than married women (AOR=3.0, 95% CI: 1.7 to 5.3, p=0.001). Another risk factor associated with testing hrHPV positive was the use of hormonal contraceptives for 5 years and above (AOR=7.0, 95% CI: 2.0 to 24.4, p=0.002). Conclusion: The study identified a low overall prevalence of hrHPV infection (2.1%) among women in hard-to-reach areas in Bangladesh, with some regional variations. Higher prevalence was observed in widowed compared with married women and among women reporting more than 5 years of hormonal contraceptive use. This study shows no evidence of particularly high-risk groups in hard-to-reach areas in Bangladesh. The findings support the feasibility of implementing a nationwide hr-HPV-based self-sampling strategy as a viable approach to reach WHO targets for reducing the burden of cervical cancer. Recommendation for policymakers to support future research to identify hrHPV prevalence among women in comparable groups in other geographically remote areas in Bangladesh. Trial registration number: NCT05234112 .

Introduction: There is a pressing need to understand and explore the complex experiences and psychosocial support needs of people LWBC‐CM and their informal caregivers, to inform survivorship and supportive care interventions.Methods: In‐depth qualitative interviews were conducted with people LWBC‐CM and their informal caregivers in Scotland, invited via primary care. One‐to‐one, face‐to‐face interviews were conducted with informed consent exploring experiences of symptoms, psychosocial support needs and interactions with health services. Interviews were transcribed and analysed using a thematic approach.Results: Forty‐one people LWBC‐CM and twenty‐three informal caregivers were interviewed. Four themes were identified: the Physical and Psychological Impact of Cancer and Comorbidity, Dominant Storie—Prioritising Conditions and Making Sense of Illness, Navigating Health Services and Treatments and Caring for People with Complex Health Conditions. Type and severity of conditions mediated people's experiences and daily living. Complex fatigue—fatigue arising from a number of health conditions—dominated symptomology. Participants navigated multiple appointments and complex medication regimes. Patients identified the need for acknowledgement of other chronic conditions and for streamlined care provision. Mutual caring and social isolation were also identified as part of the caring relationship.Conclusions: There is a mandate to address the psychosocial support needs of people LWBC‐CM, and their informal carers, given the burden of treatment for cancer survivors with moderate to severe complex conditions as they navigate health services.Patient or Public Contribution: A patient representative has been involved in all stages of the study from development of the application through study design, commenting on documentation, analysis of transcripts and writing the manuscript. They are included as an author on the manuscript.

Background: Targeted lung cancer screening is effective in reducing mortality by upwards of twenty percent. However, screening is not universally available and uptake is variable and socially patterned. Understanding screening behaviour is integral to designing a service that serves its population and promotes equitable uptake. We sought to review the literature to identify barriers and facilitators to screening to inform the development of a pilot lung screening study in Scotland. Methods: We used Arksey and O’Malley’s scoping review methodology and PRISMA-ScR framework to identify relevant literature to meet the study aims. Qualitative, quantitative and mixed methods primary studies published between January 2000 and May 2021 were identified and reviewed by two reviewers for inclusion, using a list of search terms developed by the study team and adapted for chosen databases. Results: Twenty-one articles met the final inclusion criteria. Articles were published between 2003 and 2021 and came from high income countries. Following data extraction and synthesis, findings were organised into four categories: Awareness of lung screening, Enthusiasm for lung screening, Barriers to lung screening, and Facilitators or ways of promoting uptake of lung screening. Awareness of lung screening was low while enthusiasm was high. Barriers to screening included fear of a cancer diagnosis, low perceived risk of lung cancer as well as practical barriers of cost, travel and time off work. Being health conscious, provider endorsement and seeking reassurance were all identified as facilitators of screening participation. Conclusions: Understanding patient reported barriers and facilitators to lung screening can help inform the implementation of future lung screening pilots and national lung screening programmes.

Introduction: Targeted lung cancer screening is effective in reducing lung cancer and all‐cause mortality according to major trials in the United Kingdom and Europe. However, the best ways of implementing screening in local communities requires an understanding of the population the programme will serve. We undertook a study to explore the views of those potentially eligible for, and to identify potential barriers and facilitators to taking part in, lung screening, to inform the development of a feasibility study.Methods: Men and women aged 45–70, living in urban and rural Scotland, and either self‐reported people who smoke or who recently quit, were invited to take part in the study via research agency Taylor McKenzie. Eleven men and 14 women took part in three virtual focus groups exploring their views on lung screening. Focus group transcripts were transcribed and analysed using thematic analysis, assisted by QSR NVivo.Findings: Three overarching themes were identified: (1) Knowledge, awareness and acceptability of lung screening, (2) Barriers and facilitators to screening and (3) Promoting screening and implementation ideas. Participants were largely supportive of lung screening in principle and described the importance of the early detection of cancer. Emotional and psychological concerns as well as system‐level and practical issues were discussed as posing barriers and facilitators to lung screening.Conclusions: Understanding the views of people potentially eligible for a lung health check can usefully inform the development of a further study to test the feasibility and acceptability of lung screening in Scotland.Patient or Public Contribution: The LUNGSCOT study has convened a patient advisory group to advise on all aspects of study development and implementation. Patient representatives commented on the focus group study design, study materials and ethics application, and two representatives read the focus group transcripts.

Widespread adoption of the human papillomavirus (HPV) vaccine will require population acceptance and tailoring of immunisation services to community needs and preferences. We examined peer‐reviewed publications on the acceptability of and barriers to the HPV vaccine across China. We searched English (MEDLINE, Embase, and Web of Science) and Chinese (CNKI, VIP, Wanfang data) databases between 1 January 2006 and 31 December 2017. We adopted a narrative approach for data synthesis. We identified 73 studies. The overall median acceptability of HPV vaccine was 71.8% (Q1–Q3: 58.6%–81%). Low levels of acceptability (90%) and urban eastern regions (all <35%). Despite these regional variations, common barriers to HPV vaccine acceptance were concerns about vaccine safety, uncertainty over vaccine effectiveness, low perceived risk of cervical cancer and the price of the vaccine. The level of willingness to pay for the HPV vaccine (over 153 US dollars) was very low (<7%). The acceptability of and attitudes towards HPV vaccine vary by regions and populations across China. HPV vaccination programmes will need to tailor service delivery as well as information materials to take account of regional concerns.