More people with lung cancer symptoms in the UK should be able to self-refer for tests rather than wait for their GP to request them, experts have suggested.
Making it easier for those with symptoms to get chest X-rays could help speed up diagnosis and improve survival rates from the disease, they said.
“A lung cancer diagnosis can be devastating but spotting it early can make all the difference,” said Dr Stephen Bradley, lead author of the study and a practising GP in Leeds.
The analysis, published in the British Journal of General Practice, cited self-request chest X-ray services that have been established in Leeds and Greater Manchester. Patients with symptoms such as a persistent cough, tiredness and difficulty breathing can access radiology services directly under the schemes, with the report of their X-ray sent to their GP.
The analysis highlighted that people in less affluent groups and smokers are more likely to use the service. Previous research found that the rate of diagnosis from self-referral (about 1%) is similar to those referred by their GP in the conventional way, suggesting that people use the service appropriately. The wider rollout of these services “warrants urgent consideration” given the “present difficulties patients face in accessing primary care”, according to the authors and the charity Roy Castle Lung Cancer Foundation.
Among the other recommendations made by experts is that messaging around lung cancer symptoms should be designed to reach people who have never smoked, whose symptoms can be less severe, as well as current and former smokers.
“We need to make it easier for people with symptoms to get tests like chest X-ray and ways to raise awareness of the disease, including people who haven’t smoked,” said Bradley.
“This is of course particularly pertinent in the UK as we have outcomes that have been persistently poor, compared to other high income countries,” he added.
According to the NHS, more than 43,000 people each year are diagnosed with lung cancer in the UK. Smoking is the most common cause, accounting for about 70% of cases. But a small but significant fraction – 14% – of those diagnosed with lung cancer have never smoked and the fraction has increased as smoking rates in the UK have declined. Treatment is more likely to be successful when cancer is caught early.
In June 2023, it was announced that a lung cancer screening programme, targeting those aged between 55 and 74 who are current or former smokers, would be rolled out and will be available across England by 2029. However, more than half of lung cancers arise in people who would not be eligible for screening and not all those who are eligible choose to participate.
Nick Whitehead, 58, from Newton Aycliffe, visited his GP a number of times with a persistent cough over the course of about 18 months, but was never sent for a chest X-ray. He was eventually diagnosed with lung cancer two years later when he visited A&E after coughing up blood.
“There were many opportunities for me to be diagnosed earlier,” Whitehead said. “I think I wasn’t sent for tests because I was so fit.”
“As a scuba diver, my lung capacity is good, so I wasn’t short of breath, but given that we’re constantly told that a persistent cough is a symptom of lung cancer, it’s odd that I wasn’t sent for an X-ray at the very least.”
Whitehead said he would have self-referred for an X-ray, had that been an option.
Paula Chadwick, chief executive of Roy Castle Lung Cancer Foundation, said: “Far too often we hear stories of people like Nick whose lung cancer could have been diagnosed sooner.
“It is imperative we do everything we can to change this. We are making progress, largely through screening with 76% of those caught at stages one and two.”
A Department of Health and Social Care spokesperson said: “Under this government’s plan for change to radically reform the NHS, we will fight cancer on all fronts – through prevention, diagnosis, treatment and research.
“We are committed to transforming diagnostic services, including for lung diseases, so we can catch more cases earlier and treat them faster. We will also deliver 40,000 more elective care appointments every week and invest an extra £1.5bn on new surgical hubs and AI scanners.”
