GPAtlas🧭 When to suspect
Lung cancer is the leading cause of cancer death in the UK, and the central difficulty in primary care is that early, potentially curable disease is often silent or hides behind non-specific symptoms in someone with a chronic smoker's cough. Smoking is by far the dominant risk factor, accounting for the majority of cases; other contributors include asbestos, radon, occupational carcinogens (silica, diesel fumes, arsenic), chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, and a personal or family history of cancer. The job is to apply the NICE NG12 thresholds promptly, never to dismiss haemoptysis, and to remember that a normal film does not close the case.
Mesothelioma is a separate, asbestos-driven cancer of the pleura with a latency of decades; suspect it in anyone with a relevant occupational history presenting with breathlessness, chest pain, or weight loss. Alongside symptomatic referral, the NHS Lung Cancer Screening Programme (formerly Targeted Lung Health Checks) now invites ever-smokers aged 55–74 in participating areas for a risk assessment and, if higher-risk, a low-dose CT scan.
| Action | Who to investigate (aged 40 and over unless stated) |
|---|---|
| Suspected cancer pathway referral – an urgent referral for an appointment within 2 weeks (often called 2WW) |
• Chest X-ray (CXR) findings suggesting lung cancer or mesothelioma, or • Aged 40 and over with unexplained haemoptysis – refer directly; do not wait for a CXR. |
| Offer an urgent, direct-access CXR (within 2 weeks) |
• Two or more unexplained symptoms from: cough, fatigue, breathlessness, chest pain, weight loss, appetite loss, or • Ever smoked and one or more of these symptoms. • For mesothelioma, asbestos exposure and one or more of these symptoms also qualifies. |
| Consider an urgent, direct-access CXR |
• Persistent or recurrent chest infection, finger clubbing, supraclavicular or persistent cervical lymphadenopathy, chest signs consistent with lung cancer, or thrombocytosis. • For mesothelioma: finger clubbing, or chest signs compatible with pleural disease. |
Source: NICE NG12 · NHS Lung Cancer Screening Programme
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