Lung cancer

CT-first approach urged to tackle delays in lung disease diagnosis


Patients are at risk of a delayed diagnosis of lung disease because of an ongoing reliance on chest X-rays as a first-line method of investigation, a report from the UK has warned.

The Taskforce for Lung Health, a coalition of more than 40 organisations working to improve lung health, says around one in five people with lung cancer are getting diagnosed late because of ‘ineffective’ diagnostic tests, putting them at risk of worse treatment outcomes.

They note that current guidelines recommend that most patients presenting in primary care with respiratory symptoms such as chronic breathlessness, cough or persistent chest infection, should have a chest X-ray.

However, chest X-rays “have limitations in identifying serious lung conditions such as lung cancer, as not all abnormalities are visible on an X-ray image”, the Taskforce notes.

In fact, evidence suggests that as many as 90% of lung cancer cases are missed by X-ray imaging, while it is likely that a significant number of people with idiopathic pulmonary fibrosis (IPF) are also failing to get a diagnosis with X-ray alone, “because of the low sensitivity of the imaging”, it says.

Consequently, experts are calling on the health services to promote the use of CT scanning in patients with suspected lung conditions and allow GPs to make referrals directly from primary care where necessary, because of the increased sensitivity and accuracy of CT scanning versus X-ray.

“This would give patients the best chance of early diagnosis, opening access to the best available treatments to manage their symptoms and cure or slow the progression of their disease,” the Taskforce noted.

Other recommendations in The Taskforce’s policy paper, CT-first pathways for diagnosing lung disease, include guidance, training and support for GPs to aid referral practice, that funding be made available for local implementation. They also call for a review of the costs and cost-effectiveness of different CT-first pathways, including for suspected ILD and bronchiectasis, with consideration of how increased diagnosis of different lung conditions might impact the wider workforce.

In the meantime, the Taskforce has created a new patient pathway for use by GPs to assist with the timely diagnosis respiratory symptoms and ensure better access to the right assessment tools.

“For the NHS to keep using X-rays on patients who need access to the available better technology, is a second-class service, commented Dr Alison Cook, Chair of the Taskforce. “Sending NHS patients who have urgent symptoms of lung cancer for a chest X-ray, only to have to follow up with a CT scan, is shameful. It creates needless extra work for the health service, means patients are sent back and forth for tests, causes delays and can even cost lives.”

“Sadly these new figures are yet another example of people with lung conditions being side-lined and neglected,” added Sarah Woolnough, chief executive of Asthma + Lung UK.

“About 12 million people in the UK will develop a lung condition in their lifetime but lung health is just not taken seriously – there are damaging misconceptions that prevent people getting the help they need and less than 2% of public-funded research is spent on lung conditions.”

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