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Because many nodules are benign, diagnosing malignancy is challenging and often relies on surveillance imaging. This study evaluates how frequently screen-detected lung cancers progress in tumour stage between referral and treatment within the SUMMIT LDCT screening cohort.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/upstaging-of-screen-detected-lung-cancers-during-diagnostic-assessment/349531/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/upstaging-of-screen-detected-lung-cancers-during-diagnostic-assessment/349531.png","ImageObject",300,407,{"name":92,"@type":93},"nayy☆","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-22",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",13,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What was the aim of the study on screen-detected lung cancers?","Question",{"text":113,"@type":114},"To assess how often lung cancer screening cases show cancer progression measured by tumour stage between referral and treatment.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How did the study define upstaging?",{"text":118,"@type":114},"Upstaging was defined as an increase in T-stage from referral to treatment.",{"name":120,"@type":111,"acceptedAnswer":121},"What were the main findings about upstaging and outcomes?",{"text":122,"@type":114},"Upstaging occurred in 43% of tumours, was more frequent in cT1a than cT1b or cT1c, and was associated with longer time to treatment and higher mortality (HR 1.68).","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},349531,1790529097,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":44,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},962090893153,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Lung cancer  \nOriginal research  \nUpstaging of screen-detected lung cancers during diagnostic assessment  \nMonica L Mullin  , 1,2 Priyam Verghese, 1 Chuen R Khaw, 1 Andrew Creamer, 1 Amyn Bhamani, 1 Ruth Prendecki, 1 Jennifer L Dickson  , 1 Carolyn Horst, 1  \nSophie Tisi, 1,3 Helen Hall  , 1 Kylie Gyertson,4 Esther Arthur-Darkwa,5 Laura Farrelly,6 John McCabe, 1 Ricky Thakrar  ,4 Arjun Nair,7 Anand Devaraj,8 Neal Navani  ,4 Allan Hackshaw,5 The SUMMIT consortium, Sam M Janes  1  \n► Additional supplemental material is published online only. To view, please visit the journal online ([https://doi](https://doi). org/10.1136/thorax-2025- 224006) .  \n1Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK  \n2Respirology, The University of British Columbia, Vancouver,  \nBritish Columbia, Canada 3Basildon University Hospital, Basildon, UK  \n4University College London Hospitals NHS Foundation Trust, London, UK  \n5Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK 6MRC Clinical Trials Unit at UCL, London, UK  \n7Radiology, University College Hospital, London, UK 8Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK  \nCorrespondence to  \nDr Sam M Janes; [s.janes@ucl.ac.uk](s.janes@ucl.ac.uk)  \nReceived 8 August 2025 Accepted 1 January 2026  \n© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY. Published by BMJ Group.  \nTo cite: Mullin ML, Verghese P, Khaw CR, et al. Thorax Epub ahead of print:[please include Day Month Year] . doi:10 . 1136/ thorax-2025-224006  \nABSTRACT  \nIntroduction Lung cancer is the leading cause of cancer-related death worldwide. Low-dose CT (LDCT) screening improves outcomes by detecting early-stage cancers as pulmonary nodules. As most are benign, diagnosing these nodules is challenging and often requires surveillance imaging. The aim of this study is to assess the frequency of cancer progression in a lung cancer screening study as measured by tumour stage (T-stage) .  \nMethods SUMMIT is a prospective cohort study assessing implementation of lung cancer screening with LDCT in a high-risk population. Screen-detected lung cancers with clinical tumour stage cT1a–c at time of referral were included. Upstaging was defined asan increase in T-stage from referral to treatment. The date of death was obtained from the National Cancer Registration and Analysis Service. Cox proportional hazards analysis with adjustment for age, sex, Charlson Comorbidity Index and pack years was used to assess mortality between groups.  \nResults 390 screen-detected cancers were stage cT1a–c at time of referral. Upstaging occurred more frequently in cT1a (n=48, 56%) compared with cT1b (n=83, 38%) or cT1c (n=34, 40%), p=0.01. The proportion of part-solid nodules was similar between groups (upstaged-N=47, 27%, vs not upstaged-N=45, 21%, p=0 . 19) . 43% of tumours increased T-stage from referral to first treatment (n=165) . In participants upstaged, time from referral to treatment was longer (upstaged: 84 days, 46–298 vs not upstaged: 72 days, 43–211, p=0 .04) . Adjusted overall survival analyses showed an association between upstaging and mortality (HR 1.68, 95% CI 1.13 to 2 . 51, p=0 .01) .  \nConclusion Tumour upstaging occurred in nearly half of early-stage cases in a lung cancer screening population. Tumour upstaging was associated with longer time to treatment and poorer outcomes in this population.  \nTrial registration number NCT03934866 .  \nINTRODUCTION  \nLung cancer is the biggest cause of cancer-related mortality worldwide.1 This has been attributed to its frequent presentation at late stage.2 Over the last decade, there has been a focus on researching and implementing low-dose CT scan (LDCT) to screen for lung cancer in high-risk patients.3–5  \n\n| WHAT IS ALREADY KNOWN ON THIS TOPIC\u003Cbr>⇒ Low-dose CT screening enables early detection of lung cancer in high-risk patients which improves survival.\u003Cbr>WHAT THIS STUDY ADDS |\n| --- |\n| ⇒ A s","cbCairbaCJtxQVrI","https://ap.wps.com/l/cbCairbaCJtxQVrI","pdf",1080416,"English","# Abstract\n## Introduction\n## Methods\n## Results\n## Conclusion\n# Introduction\n## Background and stage-shift\n## Diagnostic delay and outcomes","[{\"question\":\"What was the aim of the study on screen-detected lung cancers?\",\"answer\":\"To assess how often lung cancer screening cases show cancer progression measured by tumour stage between referral and treatment.\"},{\"question\":\"How did the study define upstaging?\",\"answer\":\"Upstaging was defined as an increase in T-stage from referral to treatment.\"},{\"question\":\"What were the main findings about upstaging and outcomes?\",\"answer\":\"Upstaging occurred in 43% of tumours, was more frequent in cT1a than cT1b or cT1c, and was associated with longer time to treatment and higher mortality (HR 1.68).\"}]","Upstaging of screen-detected lung cancers during diagnostic assessment | PDF",1790084218,23]