How do the UK’s guidelines on imaging for suspected lung cancer compare with other countries?

INTRODUCTION

The disappointing performance of cancer outcomes compared with other high-income countries has been a focus of health policy in the UK for decades.¹ Lung cancer is the leading cause of cancer death both worldwide and in the UK. Although improvements have been achieved in recent years, with the UK 5-year net survival for lung cancer increasing from 7.2% (95% confidence interval [CI] = 7.0% to 7.3%) in the period 1995–1999 to 14.7% (95% CI = 14.5% to 15.0%) in the period 2010–2014, these remain the poorest outcomes among comparable countries studied in an International Cancer Benchmarking Partnership (ICBP) study.² Possible explanations for this disparity of the UK include adverse comorbidity and deprivation,³ longer durations before which patients seek assessment for symptoms (patient interval),⁴ and a greater reluctance among clinicians to organise investigations for symptoms.⁵ An additional possible factor is lower availability of computed tomography (CT) and greater reliance on the less sensitive chest X-ray (CXR), which might contribute to later-stage diagnosis in the UK.^6,7

Guidance from the National Institute for Health and Care Excellence (NICE) advises GPs to investigate all patients with potential lung cancer with a CXR,⁸ other than those aged over 40 years with unexplained haemoptysis, for whom immediate referral on an urgent suspected cancer pathway is advised. In the UK, screening using CT to investigate asymptomatic patients aged 55–74 years identified as high risk because of smoking history has recently been approved by the National Screening Committee.⁹ Some have questioned whether symptomatic patients should have to rely on CXR given that the test may not identify approximately 20% of lung cancers, and whether CT should be made available as a …