Detection of Lung Cancer in Primary Care 'Inadequate and Leading to Delayed Diagnoses'

Priscilla Lynch 

October 15, 2021

The diagnosis of lung cancer following symptomatic patient presentation to primary care is inadequate and needs to improve, according to the latest safety investigation report by the Healthcare Safety Investigation Branch (HSIB).

HSIB research shows that estimated five-year survival rates in the UK are among the lowest in Europe, reflecting the fact that that two thirds of patients are diagnosed at an advanced stage.

This HSIB investigation examined the issues contributing to delayed diagnosis of lung cancer, specifically delays resulting from missed detection of possible lung cancer on chest X-rays of patients being seen in primary care.

The reference event which spurred the investigation was based on the experience of a patient who saw their GP on multiple occasions and had three chest X-rays where the possible cancer was not identified. This resulted in an eight-month delay in diagnosis and potentially limited the patient’s treatment options.

The HSIB made three safety recommendations as a result of this investigation; one to NHS England and NHS Improvement, one to the one to NHSX, and one to the National Institute for Health and Care Excellence (NICE):

  1. HSIB recommends that NHS England and NHS Improvement works with research partners to explore options for commissioning research to address whether low-dose computed tomography (CT) is clinically- and cost-effective for the diagnosis of lung cancer in symptomatic patients seen in primary care compared to chest X-ray.

  2. HSIB recommends that NICE reviews its current safety netting advice to healthcare professionals with respect to the investigation of possible lung cancer. The wording of the advice should be amended as required to make it clearer what should be offered to patients with ongoing, unexplained symptoms who have had a negative chest X-ray.

  3. HSIB recommends that NHSX, in collaboration with relevant stakeholders such as the Royal College of Radiologists and the Society and College of Radiographers, develops guidance to support independent benchmarking and validation of artificial intelligence algorithms for the identification of lung diseases such as cancer.

HSIB expects a response to its safety recommendations within 90 days of publication of the investigation report.

This article originally appeared on Univadis, part of the Medscape Professional Network.

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