Primary care professionals play a vital role in the earlier diagnosis of lung cancer. These practical tips can help you identify patients at higher risk, support timely investigations, and promote opportunities for prevention and early detection.
Lung cancer risk is impacted by both modifiable and non-modifiable risk factors.
These include:
- Older age | - Air pollution |
- Family history of cancer | - Ionising radiation |
- Medical conditions e.g. COPD | - Occupational exposures e.g. asbestos |
- Smoking (and environmental tobacco smoke)
Find out more about lung cancer risks on our webpage
Almost two-thirds (63%) of lung cancer cases in the UK are caused by smoking. Healthcare professionals have an essential role to play by supporting people to access smoking cessation services. Ask your patients about other forms of smoking tobacco (eg bidis, shisha, pipes etc.) which can also increase lung cancer risk.
Smoking shisha is most common in Southeast Asian, Middle Eastern, and North African communities. Record your patients smoking history accurately, using coding in the practice electronic health record if available – this will ensure they will be invited for lung screening if eligible. If your practice uses SNOMED codes, use NHS Digital’s SNOMED Code CT Browser to check you are coding correctly.
It is important to remember that deprivation is strongly linked to lung cancer diagnosis (1) with higher rates of smoking in more deprived groups.
Be aware of the stigma associated with smoking and lung cancer, which may affect help-seeking behaviours in these groups.
Find smoking cessation services in each nation to support your patients.
Asking about family history of lung cancer could support a future lung cancer diagnosis. The risk of lung cancer increases significantly if a sibling or parent has been diagnosed with lung cancer, independent of whether an individual has ever smoked.
For further information on family history and inherited cancer risk, visit Cancer Research UK's guidance on family history and inherited cancer genes.
Lung cancer in people who have never smoked is typically defined as someone who has smoked <100 cigarettes in their lifetime. The national lung cancer audit in England reported that every year in England, around 1,700 people who have never smoked are diagnosed with lung cancer.
Research into lung cancer in never smokers highlights several potential challenges to earlier diagnosis:
People who have never smoked may not perceive themselves as at risk from lung cancer.
There may be less urgency to seek help as symptoms are often attributed to another illness.
Presentation of symptoms can vary; often there may be fewer, less-severe symptoms in never smokers.
Lower levels of perceived risk of lung cancer may prevent people from pushing for investigations or referral.
False reassurance from an initial presentation can prevent future re-presentation if symptoms are not resolved. Encourage further assessment if symptoms do not resolve.
Often, clinicians end up relying on gut feeling, other clinical factors or patient’s ability to advocate for themselves to inform their decision making. Remain vigilant to signs and symptoms of lung cancer even in people who have never smoked. Consider other risk factors such as second-hand smoke, occupational exposures or air pollution. Where clinically appropriate, consider investigations for people regardless of their smoking history.
Chest x-rays are a useful tool for assessing lung cancer; however, they have a significant false-negative rate (approximately 20% of lung cancer cases have a CXR reported as normal), meaning a normal result does not wholly exclude lung cancer.
Following a normal chest x-ray, provide clear safety netting advice, and advise your patient to come back if symptoms persist.
If a person represents and their suspicious symptoms persist or have worsened, they may warrant further investigation e.g. a CT scan.
Our safety netting webpage offers more information and downloadable resources. You can also take our 5-minute CPD modules on safety netting on Praktiki.
The UK National Screening Committee recommend lung screening for people aged 55 – 74 with a history of smoking.
Health professionals can play an important role in supporting informed participation by identifying eligible patients, raising awareness of lung screening, and encouraging attendance.
Find out about targeted lung cancer screening on our webpage for health professionals.
This information has been written to support health professionals, academics and researchers. If you are a patient or carer, you may want to visit our public facing webpages.
You can contact our Strategic Evidence team if you have any questions.
Cancer Research UK (2018). Lung cancer risk.
Cancer Research UK (2021). Shisha, betel leaf, paan and other tobacco.
Office for National Statistics (ONS), 2023. Deprivation and the impact on smoking prevalence, England and Wales: 2017 to 2021(link is external)
Calculated by the Cancer Intelligence team at CRUK, Nov 2023. Based on National Lung Cancer Audit data for 2017-19+21. Based on lung cancer patients with a recorded smoking status; some patients without a recorded smoking status may also be never-smokers.
Black, G.B. et al., 2024. Medical Decision Making.
Cancer Research UK. Lung Health Checks
