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Missed detection of lung cancer on chest X-rays of patients being seen in primary care


The national investigation

Lung cancer is the third most common cancer diagnosed in England, but accounts for the most deaths. Five-year survival rates of those diagnosed with lung cancer are among the lowest in Europe. The low survival rate reflect the fact that two-thirds of patients with lung cancer are diagnosed at an advanced stage of the disease when curative treatment is no longer possible.

Chest X-ray is the first test used to assess for lung cancer. However, about 20% of lung cancers will be missed on X-rays resulting in a delay in diagnosis and potentially affect a patient’s prognosis.

Reference event

As an example, which is referred to as ‘the reference event’, the investigation reviewed the experience of a patient who saw their GP on multiple occasions and had three chest X-rays where the possible cancer was not identified. This resulted in an eight-month delay in diagnosis and potentially limited the patient’s treatment options.

Investigation summary

This investigation:

  • Sought to nderstand the context and contributory factors influencing a delay in lung cancer diagnosis in a patient repeatedly attending primary care with non-specific symptoms.
  • Identified the systemic factors that help or hinder the detection of lung cancer on chest X-rays.
  • Considered the utility of chest X-ray to assess for lung cancer in symptomatic patients being seen in primary care.
  • Identified the implications of the findings for mitigating the risk of delayed diagnosis of lung cancer.