Increased use of X-rays leads to earlier lung cancer diagnosis

By Stephen Beech

Increased use of chest X-rays leads to earlier lung cancer diagnosis and improved survival rates, suggests a new study.

Records of more than 170,000 lung cancer patients combined with chest x-ray rates from 7,400 GP practices were analyzed in the ground-breaking research led by the University of Sheffield.

The study, published in the British Journal of General Practice, found a "significant" link between the frequency of chest X-ray referrals from general practitioners and improved survival rates for lung cancer patients.

Lung cancer is the leading cause of cancer deaths in the UK and globally.

The research team analyzed data 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 findings showed 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 - stages 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.

Study lead author 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.”

Dr. Bradley, who conducted the study whilst at the University of Leeds, added: “While advanced technologies like CT scanners play a vital role, this study highlights the potential for optimizing 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."

Until now, it was not widely understood if GPs arranging more chest X-rays was beneficial.

The researchers said that uptake of chest X-rays varies between different general practioner practices - possibly in part because GPs may not have been convinced that there could be a benefit for patients with very common symptoms.

Study co-author Professor Willie Hamilton, of the University of Exeter, 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.”

The study, funded by Cancer Research UK, is the first of its kind to link chest X-ray rates and the national cancer registry.

Lyndsy Ambler, Senior Strategic Evidence Manager at Cancer Research UK, 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."

She added: “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.”