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Refer more patients for chest x-rays, GPs advised

GPs need to be more willing to send patients for chest X-ray, because many who turn out to have lung cancer are missed or wrongly referred, UK researchers warn.

Almost two thirds of patients with lung cancer were picked up through outpatient departments, but fewer than three-quarters of these were referred to a respiratory department, the study found.

Of patients referred to respiratory departments, 104 had received a prior chest X-ray in primary care. But the figure was far lower for patients who had been referred to other specialities, with only 40% receiving an X-ray. The research, published online by BMC Family Practice, suggested many patients with lung cancer were consulting with non-respiratory symptoms.

Around 23% of the 246 patients were admitted as an emergency, having previously described a lung cancer symptom to their doctor. Some 11% had not reported a symptom of lung before their diagnosis.

Study leader Dr Willie Hamilton, senior researcher in primary care at the University of Bristol and a GP in the city, said the findings underpinned the importance of a X-rays, even though patients with lung cancer could present with minor or even no respiratory symptoms.

He argued the threshold for ordering an X-ray could be too high. ‘Chest X-rays are cheap, accessible and low-risk. Not all patients with haemoptysis get a chest X-ray, let alone those with more common, but lower risk symptoms, like cough.

‘I think the threshold can't be nailed down to a single symptom – other than haemoptysis. GPs have to use their nous, and trust their sixth sense - that is jolly good at spotting cancers.'

Chest exam

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