In this episode we talk to Dr Stephen Bradley who is a GP and clinical research fellow at the University of Leeds.

Paper: Associations between general practice characteristics and chest X-ray rate: an observational study

https://doi.org/10.3399/BJGP.2021.0232

Abnormal findings on chest X-rays that have been requested by GPs because of symptoms are an important route to lung cancer diagnosis. Previous research has suggested that increased rates of chest X-ray and urgent referral for suspected cancer may be associated with earlier stage at diagnosis for lung cancer. This study demonstrates that there is substantial variation in rates of investigation between practices, and that only a small proportion of that variation is owing to examined population and practice characteristics. Encouraging practices that have low chest X-ray rates to lower their thresholds for investigation could prove to be an effective strategy to detect lung cancer earlier and improve outcomes.

Relevant references

Studies by CanTest Leeds team on CXR discussed in the podcast

• Systematic Review on sensitivity CXR: https://bjgp.org/content/69/689/e827
• Observational study on sensitivity of CXR: https://bjgp.org/content/71/712/e862
• Estimating risk of lung cancer following negative CXR: https://bjgp.org/content/71/705/e280
• Observational study on frequency of CXR use and practice/population characteristics: https://bjgp.org/content/72/714/e34

Remaining uncertainty regarding whether increasing GP CXR rates leads to improved outcomes

1. Lung cancer stage shift following a symptom awareness campaign (Kennedy) https://thorax.bmj.com/content/73/12/1128
2. What characteristics of primary care and patients are associated with early death in patients with lung cancer in the UK? (O'Dowd )https://thorax.bmj.com/content/70/2/161

Lung cancer screening and the place for ongoing sympatomatic detection alongside asymptomatic screening

• The proportion of lung cancer patients attending UK lung cancer clinics who would have been eligible for low-dose CT screening (Gracie) https://erj.ersjournals.com/content/54/2/1802221
• What is the balance of benefits and harms for lung cancer screening with low-dose computed tomography?  (Bradley) https://journals.sagepub.com/doi/full/10.1177/0141076821991108

Views expressed on the future of lung cancer imaging policy and research in the UK

• Evidence submitted to health & social care parliamentary select committee inquiry on cancer services (Bradley) https://committees.parliament.uk/writtenevidence/38850/pdf/