P168 Reassessment of ‘moderate risk’ lung cancer screening participants in the Somerset, Wiltshire, Avon and Gloucester (SWAG) cancer alliance

Introduction: NHS England’s Lung Cancer Screening (LCS) programme identifies individuals at high risk of lung cancer using the PLCO₂₀₁₂ and LLP_v2 risk models. National guidance advises that participants who do not initially meet the risk threshold should be reassessed at the point they are likely to become high risk. However, as an evolving programme, the optimal timelines for reassessment and the associated clinical implications are not known. We evaluated the rate of conversion to high-risk and subsequent screening outcomes of a cohort of ‘moderate-risk’ people who were reassessed at 24 months.

Methods: Individuals with an initial PLCO₂₀₁₂ score of 1.3–1.5% or LLP_v2 score of 2.0–2.49% were reassessed between January and June 2025. We documented cases where reassessment resulted in a high-risk score, i.e. LLP_v2 ≥2.5 or PLCO₂₀₁₂ ≥1.51, and investigated the change in risk variables between the two assessments. For participants who converted to high-risk, we described scan results and clinical outcomes.

Results: 337 individuals met the criteria for reassessment, of whom 230 (68.2%) converted to high-risk on reassessment: 106 (31.5%) on LLP_v2 criteria, 41 (12.2%) on PLCO₂₀₁₂ criteria and 83 (24.6%) on both. To date, 148/230 (64.3%) have undergone CT scans, with the remainder awaiting scheduling. Most scans (n=127/148; 85.7%) were normal and participants will undergo 24-month follow-up. 16/127 participants (10.8%) entered nodule surveillance pathways, whilst 5/127 (3.4%) had abnormal imaging necessitating Screening Review Meeting discussion and/or referral to secondary care cancer services.

Age, smoking duration, new diagnoses of airways disease, personal history of cancer, and family history of lung cancer were the factors that most often changed between assessments, driving increases in risk scores (table 1).