Self-request chest x-ray services—reducing barriers to diagnosis of lung cancer

Despite the welcome introduction of the NHS Lung Cancer Screening Programme, most diagnoses of lung cancer will continue to be made via symptomatic and emergency presentations. Multiple patient-related factors act as a barrier to symptomatic presentation and eventual diagnosis including perceptions of personal risk and a view that the often non-specific symptoms may be unworthy of medical attention in an ever-busy NHS. Self-request chest x-ray services rolled out in Leeds and Greater Manchester aim to reduce these barriers to diagnosis in order to achieve earlier diagnosis of lung cancer and improve outcomes. The services have been accessed over 14 000 times. Lung cancer is a leading cause of health inequality, and these services effectively target populations with high levels of deprivation who are at the greatest risk of lung cancer and yet face the greatest barriers to diagnosis. Self-request services empower patients to take ownership of their health. Supported by organizations representing those affected by lung cancer, the initiative is a step towards restoring access to healthcare. This commentary discusses the rationale for the self-request chest x-ray service and describes the service model, addressing areas of potential concern and controversy.