Early diagnosis of lung cancer is key in primary care

Primary healthcare professionals can play a key role in improving survival from lung cancer by treating tobacco dependency earlier, raising awareness of symptoms, collecting data accurately and encouraging reluctant patients to present.

This is the message of a review of the presentation of lung cancer in primary care published in NPJ Primary Care Respiratory Medicine.

Lead author David Weller, James Mackenzie Professor of General Practice at the Usher Institute, University of Edinburgh, says poor outcomes are linked to late presentation, yet early diagnosis can be challenging as lung cancer symptoms are common and non-specific.

In the UK GPs will on average diagnose only one or two cases of lung cancer a year but will see hundreds of patients with common symptoms, such as cough, breathlessness and chest pain —hence, there are significant difficulties in identifying, diagnosing and referring these patients in a timely manner.

To improve early diagnosis of lung cancer Professor Weller says primary healthcare professionals could:

• Engage in service re-design and identify more streamlined diagnostic pathways
• Incorporate decision support into their consulting, based on validated lung cancer risk models.
• Ensure they are central to recruitment in future lung cancer screening programmes as they are uniquely placed to ensure the right people are targeted for risk-based screening programmes.

In another recent paper in the Journal of the Royal Society of Medicine, a group of respiratory medicine and public health experts, led by Anand Bhopal, of the Health Protection and Medical Directorate of Public Health England, say that lung cancer in people who have never smoked is under recognised and presents a diagnostic challenge. This is a concern for GPs seeking to balance over-investigation with early diagnosis and high quality care.

It is estimated that around 6,000 people in the UK who have never smoked die of lung cancer every year.  Major contributors to lung cancers in never-smokers include second-hand smoke, occupational carcinogen exposure and outdoor pollution. 

Steve Holmes, PCRS Education Lead says:  “These two review articles are really worth a read from a primary care perspective. The Bhopal paper highlights the prevalence of carcinoma of the lung in non - smokers (6000) being greater than cervical cancer and ovarian cancers combined - and remind us of the potential risk factors, but importantly not to make assumptions that carcinoma of the lung will only affect smokers.

“Whilst the Weller paper highlights the need for us to not only be aware of those symptoms and signs that may help us make an early diagnosis - but also to think about how we can reduce the stigma that has been identified in people not wanting to trouble the doctor and ensure that once a problem is identified their route the NHS is rapid and thorough without undue delays.”

Carol Stonham, PCRS Executive Vice Chair, says: “It is well recognised that we need to spot lung cancer as early as possible allowing access to effective treatments. Rather than simply reminding us of that, these papers give some ideas on how this can be achieved. There is an accepted association between smoking and lung cancer leaving lung cancer in people who have never smoked often being overlooked yet as is demonstrated here, around 6000 people who have never smoked die from lung cancer each year.

“Lung cancer needs to be in the forefront of our minds in all symptomatic patients to improve early detection, access to the newer effective treatments, and survival for these people.”

Resources:

• NICE has recently released guidance on diagnosis and management of lung cancer.
• PCRS Education Lead Steve Holmes explains the importance of tackling smoking cessation and early diagnosis of lung cancer in this Primary Care Respiratory Academy podcast.
• Use the PCRS guide to managing tobacco dependency to help your patients to quit.
• Attend a hands-on smoking cessation techniques workshop is being held at the PCRS Respiratory Conference 2019 in Telford on 19-21 September