A new UK study has found an association between chest x-ray usage and lung cancer outcomes in general practice.
Practices with higher chest x-ray use detected lung cancer earlier than practices with lower usage, leading to better outcomes for patients, UK research has shown.
“This study provides the most persuasive evidence of beneficial lung cancer outcomes associated with increased utilisation of chest x-ray in symptomatic primary care populations to date,” the authors concluded.
Researchers used data from the UK National Health Service’s Diagnostic Imaging Dataset and the National Cancer Registration and Analysis Service for almost 200,000 individuals diagnosed with lung cancer to determine whether general practices that request a greater number of chest x-rays detect a greater number of lung cancer cases at an earlier timepoint compared to practices that make fewer requests.
After accounting for factors such as age, sex, socioeconomic status and smoking habits, patients at practices in the highest quintile for chest x-ray utilisation had a 13% reduction in the odds of being diagnosed with advanced stage lung cancer compared to patients at practices in the lowest quintile, while patients in the second highest quintile for x-ray use had their odds reduced by 7%.
Patients at practices in the highest quintile for chest x-ray usage also had better survival at both one year (8% less likely to die) and five years (5% less likely to die) compared to patients at practices in the lowest quartile for chest x-ray usage.
“Achieving earlier diagnosis of lung cancer is appropriately considered an urgent priority in cancer policy,” the study authors noted.
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“Due to the typical symptom profile of lung cancer, in which low-risk symptoms predominate, prompt diagnosis is challenging. As lung cancer screening is likely to only identify a minority of cancers, investigation of patients who are symptomatic remains vital.
“Despite the limitations of CXR, this study has demonstrated that higher utilisation of the test is associated with improved outcomes. Given the substantial variation that exists in the rates of investigation with CXR in primary care, initiatives to increase CXR utilisation may be warranted as part of a wider strategy that includes lung cancer screening using low-dose CT, public awareness of symptoms, and greater availability of more-definitive modalities, such as CT.”
Australia is set to launch a national, risk-based lung cancer screening program later this year, after Federal health minister Mark Butler announced the scheme in 2023. Symptom-free individuals will be eligible for the program if they have a history of at least 30 pack-years of cigarette smoking for current smokers or have a history of at least 30 pack-years of cigarette smoking and have quit in the last decade.
