Targeted Lung Health Check (TLHC) program

Overview

Targeted Lung Health Checks have been offered in BNSSG since 2023 as part of the national TLHC program Lung health checks - NHS (www.nhs.uk). The program is delivered “in the round” at PCN level meaning patients are invited to attend when the program comes to their PCN. The decision of the order of onboarding of PCNs has been made according to need.

People aged 55-74 with an “ever smoked” code on their primary care record will be offered a TLHC on a two yearly basis until they age out of the program. Patients without a smoking code are also invited to an appointment.

The initial appointment is a telephone risk assessment. Those people deemed to be high risk (on the basis of a validated tool) are invited to attend for a low dose CT chest (LDCT).

Results of the LDCT are communicated to the patient and their primary care provider with onward referral for lung cancer and follow up of lung nodules being organised by the TLHC team.

The images and full CT reports are not available on ICE. If access to the full CT report is needed this can be obtained by contacting the InHealth operations team on swag.lunghealthcheck@nhs.net.

If patients present with symptoms having had a TLHC then these symptoms should be investigated as indicated from history and examination. A repeat chest CT within three months is unlikely to show lung cancer but may show other findings. The TLHC CT does not include the abdomen or pelvis.

Incidental Findings

***Update July 2024*** There are currently system level conversations concerning the optimal management of incidental findings from the TLHC program. Please can you follow the guidance offered by the program to assess these patients as per the correspondence from the TLHC program until a system agreement is reached. **

The aim of the TLHC program is to diagnose lung cancer at an earlier stage. Other CT findings may require investigation outside of the lung cancer pathway.

Incidental findings are only reported to participants and primary care if they are a NEW finding. If the participant already has a known diagnosis of cardiovascular disease, COPD or aortic valve disease, or if they are already on appropriate treatment, then the finding is not reported by the TLHC team and no further action is required from primary care.

The two most common incidental findings are coronary artery calcification (CAC) and Emphysema both of which offer an opportunity for early intervention and improved outcomes for patients. Aortic valve calcification is another finding that may require clinical assessment and onward referral by a GP if indicated. It should be noted that these findings are not diagnostic for underlying disease but are only indicators that further checks may be required and/or risk factors addressed.

The national TLHC team have asked local systems to agree the management of incidental findings until a national SOP is developed. Within BNSSG these local pathways include managing findings within the TLHC program where appropriate alongside referrals into primary or secondary care for further assessment.

Smoking Cessation advice should be offered to all patients who smoke.

Coronary Artery Calcification

Please see the Coronary Artery Calcification page for advice on assessment and management in primary care and when to refer.

Aortic Valve Calcification

Guidelines on management of aortic valve calcification following THLC is being discussed at a national and local level. Following recent discussions with local specialists and the GPCB a holding position has been agreed on while awaiting development of a suitable pathway that is resourced. This is dependent on the severity of the radiological findings and in line with NICE (NG208)-  Heart valve disease presenting in adults: investigation and management | NICE:

Mild Calcification - this will not be reported and no further intervention is required by secondary or primary care.

Moderate or Severe Calcification - patient and GP will be sent a letter and patient advised to make an appointment with GP to discuss the findings. The patient should have initial work up in primary care to include: 

• History to illicit any possible symptoms (e.g Chest pain, breathlessness)
• Physical examination to include check for heart murmurs, pulse and BP.
• Echocardiogram if there is a heart murmur.
• ECG if there are other symptoms suggestive of cardiac disease.
• Referral on to cardiology (valve clinic) via eRS if there aortic valve disease suspected on echo or other appropriate referral or advice and guidance if other symptoms or abnormal ecg.

Emphysema

Mild Emphysema -  this will not be reported and no further intervention is required by secondary or primary care.

Moderate or Severe Emphysema - patients and GP will be sent a letter and patient advised to make an appointment with GP to discuss findings. If the patient has symptoms of breathlessness then spirometry. should be arranged.

If COPD is confirmed then please manage accordingly. See the Chronic Obstructive Pulmonary Disease page.

Resources

Patient resources - including information in several languages is available on the SWAG website.

Somerset, Wiltshire, Avon and Gloucestershire Cancer Alliance’s Targeted Lung Health Checks (swaglunghealthcheck.nhs.uk)

GP and Patient Letters

Text of letters sent to patients and GPs following incidental findings.

Smoking Cessation

See the Smoking Cessation page for advice about local support.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.