Increased use of chest x-rays linked to earlier lung cancer diagnosis and improved survival

A groundbreaking study has revealed a significant link between the frequency of chest x-ray referrals from GPs and earlier diagnosis and improved survival rates for lung cancer patients.

A partnership led by the University of Sheffield, involving the University of Exeter, analysed records from more than 170,000 lung cancer patients in England between 2014 and 2018, combined with chest x-ray rates from 7,400 GP practices.

The study, published in the British Journal of General Practice, found that patients attending practices with the highest chest x-ray usage were more likely to be diagnosed with lung cancer at an earlier, more treatable stage. The practices with the highest chest x-ray usage also saw patients less likely to be diagnosed at the later stages of cancer – stage three and four.

These patients were also shown to have better survival at both one and five years after diagnosis, compared with those with the lowest chest x-ray usage.

Lead author of the study, Dr Stephen Bradley from the University of Sheffield’s School of Medicine and Population Health, said: “Lung cancer remains the leading cause of cancer deaths both in the UK and globally. This is an important step forward in our understanding of how to improve lung cancer detection. Our research strongly suggests that increasing the use of chest x-rays for patients with relevant symptoms can lead to earlier diagnosis and, crucially, better chances of survival.”

Until now, it was not widely understood if GPs arranging more chest x-rays was beneficial. The uptake of chest x-rays varies a great deal between different GP practices – possibly in part because GPs may not have been convinced that there could be a benefit for patients with very common symptoms.

Dr Stephen Bradley said: “While advanced technologies like CT scanners play a vital role, this study highlights the potential for optimising the use of a simpler, cheaper tool like x-rays which are easier for patients to access. By encouraging greater use of chest x-rays, we can potentially diagnose lung cancer earlier, when treatment is more likely to be successful.”

Professor of Primary Care Diagnostics at the University of Exeter and Co-author of the study, Willie Hamilton CBE, said: “This study matters. There’s few cancer tests available in general practice which are fairly accurate, fairly cheap and very acceptable to patients. Now we know that doing more chest X-rays finds more cancers, and identifies them earlier in their growth, which is crucial to the best outcomes for patients.”

This is the first study of its kind which links chest x-ray rates and the national cancer registry. The study was funded by Cancer Research UK.

Senior Strategic Evidence Manager at Cancer Research UK, Lyndsy Ambler, said: “This study highlights how the use of investigations in primary care can help diagnose cancer at an earlier stage to give people affected by cancer the best chance of a good outcome. Encouraging the use of chest x-ray for people with potential signs and symptoms of lung cancer by GPs and improving GP access to investigations is key. More research to understand the impact of other investigations used in primary care on patient outcomes is also needed to support efforts to diagnose cancer earlier.”