Background National guidelines in England recommend prompt chest X-ray (within 14-days) in patients presenting in General Practice with unexplained symptoms of possible lung cancer, including persistent cough, shortness of breath or weight loss.

Aim To examine time to chest X-ray in symptomatic patients in English General Practice prior to lung cancer diagnosis and explore variation by demographics.

Design and Setting Retrospective cohort study using routinely collected General Practice, cancer registry and imaging data from England.

Method Patients with lung cancer who presented symptomatically in General Practice in the year pre-diagnosis and had a pre-diagnostic chest X-ray were included. Time from presentation to chest X-ray (presentation-test interval) was determined and intervals classified based on national guideline recommendations as concordant (≤14 days) or non-concordant (>14 days). Variation in intervals was examined by age, sex, smoking status and deprivation.

Results In a cohort of 2102 lung cancer patients, the median presentation-test interval was 49 days (interquartile range, IQR:5-172). 727 (35%) patients had presentation-test intervals of <14 days (median:1 day; IQR:0-6) and 1375 (65%) had presentation-test intervals of >14 days (median:128 days; IQR:52-231). Intervals were longer among smokers than non-smokers (equivalent to 63% longer; p<0.001), older patients (equivalent to 7% longer for every 10-years; p=0.013) and females (equivalent to 12% longer than males; p=0.016).

Conclusion In symptomatic primary care patients who underwent chest X-ray before lung cancer diagnosis, only 35% were tested within the timeframe recommended by national guidelines. Smokers, older patients and females experienced longer intervals. These findings could help guide initiatives aimed at improving timely lung cancer diagnosis.