Implications of incidental findings from lung screening for primary care: data from a UK pilot

Emily C Bartlett,Maria Martins,Samuel V Kemp,Simon Padley,Jaymin B Morjaria,James Addis,Pritti Vaghani,Saeed Mirsadraee,Sarah Whiteside,Sujal R Desai,Carole A Ridge,Katie Morris,Anand Devaraj,Jonathan Belsey,Jane Derbyshire,Michelle Chen

doi:10.1038/s41533-021-00246-8

Abstract

Regional lung cancer screening (LCS) is underway in England, involving a “lung health check” (LHC) and low-dose CT scan for those at high risk of cancer. Incidental findings from LHCs or CTs are usually referred to primary care. We describe the proportion of participants referred from the West London LCS pilot to primary care, the indications for referral, the number of general practitioner (GP) attendances and consequent changes to patient management, and provide an estimated cost-burden analysis for primary care. A small proportion (163/1542, 10.6%) of LHC attendees were referred to primary care, primarily for suspected undiagnosed chronic obstructive pulmonary disease (55/163, 33.7%) or for QRISK® (63/163, 38.7%) assessment. Ninety one of 159 (57.2%) participants consenting to follow-up attended GP appointments; costs incurred by primary care were estimated at £5.69/LHC participant. Patient management changes occurred in only 36/159 (22.6%) referred participants. LHCs result in a small increase to primary care workload provided a strict referral protocol is adhered to. Changes to patient management arising from incidental findings referrals are infrequent.

Highlights

Targeted lung cancer screening (LCS) with CT is being introduced in the UK, via a number of pilot programmes
The model of lung screening that has been most widely used in the UK to date involves so-called “lung health checks” (LHCs)[1,2,3,4], comprising a clinical consultation, spirometry, and a lung cancer risk score calculation
The clinical consultation and spirometry within the LHC allow for the identification of wider health issues, such as potentially undiagnosed chronic obstructive pulmonary disease (COPD)[8,10], while the identification of coronary calcification on low-dose computed tomography (LDCT) can be used as a marker of cardiovascular risk to identify participants who may benefit from lipid-lowering therapy[7]

Summary

Introduction

Targeted lung cancer screening (LCS) with CT is being introduced in the UK, via a number of pilot programmes. The model of lung screening that has been most widely used in the UK to date involves so-called “lung health checks” (LHCs)[1,2,3,4], comprising a clinical consultation, spirometry, and a lung cancer risk score calculation. In these pilot programmes, the lung cancer risk score calculation is used to determine eligibility for a low-dose computed tomography (LDCT) scan. Individuals with non-malignant incidental findings in targeted lung screening pilots are typically referred to primary care for further management This includes both incidental findings identified at LDCT, as well as conditions such as suspected undiagnosed COPD identified as part of the LHC. No prior work has evaluated the overall financial cost to primary care, resulting from referrals from LCS programmes

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