Changes in diagnostic evaluation of patients with lung cancer symptoms

When high-risk patients present lung cancer symptoms (LCSs) in general practice, Computed Tomography of the thorax (CT thorax) is recommended, but chest X-ray (CXR) may still be used often. This population-based study aims to 1) compare the proportion of patients who completed diagnostic evaluation, and 2) analyse the associations between smoking status, symptom burden and first choice of imaging among patients who presented LCS to their general practitioner (GP) in 2012 and 2022.

Two random samples of 100,000 individuals ≥20 years were invited to a survey about symptoms and healthcare seeking in 2012 and 2022, respectively, with subsequently linkage to register data. We included individuals ≥40 years old who reported GP contact with LCSs. Descriptive statistics and multivariable regression models were applied.

A total of 5910 (16%) and 4883 (22%) individuals reported at least one LCS in 2012 and 2022, respectively, and 2538 (43%) and 2229 (46%), respectively, had contacted their GP. Diagnostic imaging was completed by 2538 (24%) in 2012 and 2229 (22%) in 2022. CXR was the most common first choice of imaging in both years (22% and 15%, respectively), although CT thorax as first choice increased from 2% to 7%. Higher symptom burden and former smoking increased the odds of completing diagnostic imaging while current smoking did not.

One out of five patients with lung cancer symptoms completed diagnostic evaluation. CXR remained first choice, although more completed CT thorax in 2022. GPs may need tools to support risk stratification and choice of imaging.