![]() The period of 1 year was selected with reference to estimates of detectable pre-clinical phase of lung cancer (mean sojourn time), 27 estimated to be between 5.5 months 28 and 2.2 years. The authors considered any study that reported the number of adult patients who had a chest X-ray following a symptomatic presentation to a clinician in the year before diagnosis with lung cancer. These findings support calls to increase open-access CT for GPs, but, given resource restrictions and the potential to cause harm through overdiagnosis, further research is required to help identify which patients who have had a non-diagnostic chest X-ray should be referred for additional investigation. As earlier diagnosis is closely associated with improved survival, it is therefore possible that the use of chest X-ray in UK practice may delay the diagnosis of lung cancer in some patients. The few high-quality studies identified suggest that chest X-ray misses (at least initially) lung cancer in >20% of people. This systematic review found that there is limited high-quality evidence published on the diagnostic accuracy of chest X-ray. Outcomes for lung cancer are relatively poor compared with the healthcare systems of many other advanced economies, which make more extensive use of other imaging modalities such as computed tomography (CT). The websites of several organisations 12 – 26 were manually searched to identify any potentially eligible reports, guidelines, and audits (grey literature search).Ĭhest X-ray remains the first-line investigation for suspected lung cancer in the UK. The reference lists of included articles were screened. The full search strategies are available from the authors on request. The searches were peer reviewed and updated in December 2018 in all the databases. Only studies published after 1999 were included in order to ensure that evidence reflected contemporary radiological technology and practice. These resources were searched with no language restrictions from 1999 using a search strategy with subject headings and free-text words for the concepts ‘chest X-ray’ and ‘lung cancer’. In July 2017 the authors searched CINAHL, Cochrane Database of Systematic Reviews (CDSR), Cochrane Controlled Register of Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA), NHS Economic Evaluation Database (NHS EED), EMBASE, MEDLINE, MEDLINE in process, MEDLINE Epub ahead of print, PubMed, and Science Citation Index (SCI). 10ĭespite its predominance in guidelines and clinical practice, no systematic review has determined the sensitivity of chest X-ray alone for lung cancer in patients presenting with symptoms, which is the aim of the present study. 8 Outcomes for lung cancer in the UK remain poor compared to other advanced economies, 9 where modalities such as computed tomography (CT) are used more extensively. 7 This is reflected in current National Institute for Health and Care Excellence lung cancer guidelines, which recommend chest X-ray for initial evaluation in all patients, aside from those aged >40 years who have unexplained haemoptysis. 6 It remains the first-line investigation for lung cancer in primary care and the most common radiological route to diagnosis. 4 Chest X-ray is comparatively cheap, accessible, 5 and has a low radiation dose. ![]() Optimising early detection is therefore considered an important strategy in improving outcomes. 3ĭiagnosis of lung cancer at earlier stages of disease is associated with improved survival. The age-standardised 5-year survival rate has only increased from approximately 5% to 10% since 1971, 2 compared with improvements from 53% to 87% in the 5-year survival rate for breast cancer in the same period. 2 Compared with many other cancers, improvements in lung cancer survival over recent decades have been modest. Lung cancer is the single largest cause of cancer mortality both worldwide 1 and in the UK. ![]()
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