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Lung Cancer. 2018 Oct;124:160-167. doi: 10.1016/j.lungcan.2018.08.001. Epub 2018 Aug 3.

Lung cancer CT screening: Psychological responses in the presence and absence of pulmonary nodules.

Author information

University of Nottingham, Division of Primary Care, United Kingdom.
University of Nottingham, Division of Medical Sciences and Graduate Entry Medicine, United Kingdom.
University of Nottingham, Institute of Mental Health, United Kingdom.
University of Dundee, Tayside Clinical Trials Unit, United Kingdom.
University of St Andrews, School of Medicine, United Kingdom.
University of Glasgow, General Practice and Primary Care, United Kingdom.
University of Dundee, Scottish Centre for Respiratory Research, United Kingdom.
University of Nottingham, Division of Primary Care, United Kingdom. Electronic address:



To determine the psychological response (thoughts, perceptions and affect) to a diagnosis of pulmonary nodules following a novel antibody blood test and computed tomography (CT) scans within a UK population.


This study was nested within a randomised controlled trial of a blood test (Early CDT®-Lung test), followed by a chest x-ray and serial CT-scanning of those with a positive blood test for early detection of lung cancer (ECLS Study). Trial participants with a positive Early CDT®-Lung test were invited to participate (n = 338) and those agreeing completed questionnaires assessing psychological outcomes at 1, 3 and 6 months following trial recruitment. Responses of individuals with pulmonary nodules on their first CT scan were compared to those without (classified as normal CT) at 3 and 6 months follow-up using random effects regression models to account for multiple observations per participant, with loge transformation of data where modelling assumptions were not met.


There were no statistically significant differences between the nodule and normal CT groups in affect, lung cancer worry, health anxiety, illness perceptions, lung cancer risk perception or intrusive thoughts at 3 or 6 months post-recruitment. The nodule group had statistically significantly fewer avoidance symptoms compared to the normal CT group at 3 months (impact of events scale avoidance (IES-A) difference between means -1.99, 95%CI -4.18, 0.21) than at 6 months (IES-A difference between means 0.88, 95%CI -1.32, 3.08; p-value for change over time = 0.003) with similar findings using loge transformed data.


A diagnosis of pulmonary nodules following an Early CDT®-Lung test and CT scan did not appear to result in adverse psychological responses compared to those with a normal CT scan.


Lung cancer screening; Psychological impact; Pulmonary nodules

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