Stephen Bradley is a GP, NIHR Academic Clinical Lecturer at the University of Leeds and clinical lead for cancer in the Leeds office of the West Yorkshire Integrated Care Board. Last year, with our funding, he completed a PhD on lung cancer diagnosis.
Stephen is one of the experts helping to shape our Manifesto for Cancer Research and Care. Our Manifesto, which will be published in November, will set out how the next Government can transform cancer outcomes for all.
Lung cancer takes more lives than any other cancer type in the UK.
It can affect anyone, but it’s usually caused by smoking, which is more common in more deprived areas. That makes lung cancer a key reason why, on average, people living in the North of England and disadvantaged areas of Northern Ireland, Wales and Scotland die much younger than those in more affluent parts of the country.
The problem is made worse by the fact that, when it comes to diagnosing lung cancer, the UK lags behind other countries with similar healthcare systems. Patients here are more likely to be diagnosed with the disease after it has reached its later stages, and, as a result, they are less likely to survive it.
NHS England’s decision to roll out a lung cancer screening programme using low dose CT scans for those at higher risk of the disease can help change that. It will find more lung cancer cases early, when doctors have the best chance of treating them successfully. Wales, Scotland and Northern Ireland should follow suit and launch their own screening programmes as soon as possible.
But screening isn’t a silver bullet. Only those at the highest risk will be eligible and some will choose not to participate. With around 10 to 15% of all lung cancer cases in non-smokers, we need to think about using other tools as well.
Chest x-rays aren’t perfect tests, but as some lung cancer symptoms (like cough) are extremely common, they remain useful for many patients. But there are big differences in how often general practices use chest x-rays, even accounting for factors like patients’ age and smoking rates.
Research currently under review suggests that patients with lung cancer registered at practices that use chest x-rays more often are diagnosed with earlier stage disease and have improved survival. So, supporting practices to make more use of chest x-rays could be a way to improve outcomes.
Possibilities like that show how important it is that GPs and NHS managers can find out how their practices use chest x-rays. There’s room for improvement there. The data is already collected but needs to be shared openly.
And there are other ways to increase uptake. In Leeds, where I work, there’s a self-request service that allows patients with possible lung cancer symptoms to organise their own x-ray without seeing a GP. It’s been accessed by patients more than 12,000 times since it was first launched over ten years ago. A similar service has recently started operating in Manchester.
These services are especially valuable because of the gaps they fill and the options they give to patients. Some people with possible symptoms of lung cancer can be reluctant to talk to health care professionals and would rather schedule a test directly. Others can find it difficult to get appointments, so removing the requirement to speak to a GP first can make things easier. As those problems aren’t confined to Manchester and Leeds, setting up self-request chest x-ray services throughout the country should be a priority.
Similarly, patients attending their local general practices often see professionals other than GPs. But practice nurses, for instance, usually can’t organise chest x-rays themselves. Changing that could also streamline access to investigations. It’s already happening in some areas, and we should evaluate it carefully to see if it can help improve diagnosis for more people with lung cancer.
None of that would change what we can learn from x-rays, or how quickly we can read them, but there are the opportunities there, too. AI might be able to speed up the process of interpreting x-ray images, or even, one day, spot cancers humans miss.
Several companies are now offering AI chest x-ray products to the health service and the NHS is being funded to procure these. As recently highlighted by the National Institute of Health and Care Excellence, we urgently need to understand how well these products work.
Given its scale, and the millions of chest x-ray images and tens of thousands of lung every year, the NHS might be the best organisation in the world to evaluate how well these systems work and compare them to each other.
This would bring desperately needed clarity around effectiveness and drive AI developers to compete and improve accuracy. If we make the most of this opportunity, we wouldn’t be playing catch-up with the rest of the world: we’d be guiding everyone towards a healthier future.
The UK’s researchers have been doing that for a long time, contributing to immunotherapies and treatments targeted to individuals’ specific tumour types that are already helping more patients survive lung cancer.
Our national cancer audits give invaluable insights on how well the NHS does in getting these treatments to patients. But these can also be improved. For the NHS to fulfil its commitment of tackling health inequalities, national cancer audits should begin to report outcomes by deprivation category.
As we’ve seen, that’s especially important for lung cancer. And it would allow bodies like Integrated Care Boards to identify differences in uptake of the most effective treatments between different groups so that we can shrink this unfair ‘deprivation gap’.
In time, even more effective treatments will become available. But the chances of good outcomes will still depend on when lung cancers are diagnosed. There are simple actions we can take to make a difference. We can’t afford to wait.