There is no doubt screening will be the biggest step forward in detecting lung cancer early. However, it is not the complete solution.
The programme targets people at highest risk. This means most lung cancer cases will still be diagnosed after symptoms appear. We see it as our responsibility to find ways to spot these cases earlier.
40 Heads Are Better Than One
On Wednesday 8th March, we gathered around 40 healthcare professionals across the lung cancer pathway. This included GPs, radiographers, chest physicians, oncologists, and members of the NHS Cancer Programme team. We aimed to generate new ideas for early detection.
Discussions quickly focused on access to primary care. Consultant Chest Physician Dr Matthew Evison shared details of a new drop-in chest x-ray service piloted in Greater Manchester.
Residents in Bury, Heywood, Rochdale, and Middleton aged 40 or over with symptoms like a cough, shortness of breath, or fatigue lasting three weeks or more can now get a chest x-ray without seeing a GP.
“We want to make it as easy as possible for people with symptoms to get checked,” explains Dr Evison.
“This scheme offers peace of mind for those worried about their health. It also helps identify cases that need attention quickly. Conditions like lung cancer are more treatable when caught early. This service aims to enable timely diagnosis and prolong lives.
“The service has worked well so far. Many people have used the three participating hospitals: Fairfield Hospital, The Royal Oldham Hospital, and Rochdale Infirmary.”
Overcoming Hesitancy Around X-Rays
Chest x-ray is the starting point for most lung cancer journeys. During the workshop, some participants highlighted GP hesitancy in referring patients for x-rays.
We discussed this with radiographer Dr Nick Woznitza. He explained how radiographers and radiologists could reassure GPs and encourage referrals.
“It’s understandable why some GPs hesitate or worry a referral may be rejected. I have never known a radiographer to reject a chest x-ray request for suspected lung cancer. The only time a referral is queried is if the patient had a recent x-ray. We need to get this message across and reassure GPs. X-rays can detect many conditions, not just lung cancer.”
Dr Katherine Hickman, a GP in Bradford, agrees. “Chest x-rays are useful for many issues. GPs routinely order blood tests for many symptoms. Normalizing chest x-rays in the same way would be a big step forward.”
We are now working with Dr Hickman and Dr Woznitza to remove barriers to chest x-rays and improve communication between primary and secondary care.
Let’s Talk Lung Cancer
With ideas to tackle the hurdles within primary care taking shape, attention turned to a wider issue – before a person even gets into a GP consultancy room.
Despite the huge numbers of people affected by lung cancer, lack of knowledge or awareness remains high. Vagueness of symptoms, symptom overlap, and disease misconceptions mean many people don’t seek help as soon as they could. This, coupled with the associated stigma and nihilistic perceptions that are intrinsically linked to lung cancer, are all contributing to later diagnosis.
In late 2022, we partnered with NHS England and toured the country with our giant inflatable lungs to raise awareness of lung cancer and start much-needed conversations around the disease.
Lung cancer is a disease that no one wants to talk about but, by being more open about a disease that affects so many of us, and helping to recognise the symptoms and encourage them to take immediate action, can save lives.
Standing 12ft high, the MegaLungs are a sight to behold and provide an ideal icebreaker to this taboo topic. Large enough for visitors to step inside, they can learn about typical lung structures, lung health and the effects of smoking.
Trained community engagement teams and patient advocates were then on hand to talk about suspected symptoms and encourage them to visit their GP or, for those encountering difficulties seeing a GP, to contact our Ask the Nurse helpline for advice and support.
We are now working to replicate this activity in our campaign for lung cancer awareness month 2023.
Work to do
Early detection has never been more imperative. Latest research has revealed a “universal” cure for cancer is “unlikely anytime soon”.
The study – entitled TracerX and funded predominately by Cancer Research UK – tracked lung cancers for nine years. It has provided the most in-depth analysis of how cancers evolve and what causes them to spread.
“It has surprised me how adaptable tumours can be,” Prof Swanton, lead researcher on TracerX, told the BBC Health and Science correspondent, James Gallagher.
“I don’t want to sound too depressing about this, but I think – given the almost infinite possibilities in which a tumour can evolve, and the very large number of cells in a late-stage tumour, which could be several hundred billion cells – then achieving cures in all patients with late-stage disease is a formidable task.
“If we want to make the biggest impact we need to focus on prevention, early detection and early detection of relapse.”
In short, the best way to stop lung cancer is to catch it at its earliest stage. And that’s what we intend to do.