Targeted Lung Health Checks (TLHCs) is a lung cancer screening programme for those who smoke, or who have ever smoked, and are aged between 55 and 74.

This programme can find other lung condition (which we call ‘incidental findings’), such as emphysema.

The programme’s ability to find these incidental findings means it has the potential to deliver considerable benefits beyond the diagnosis of lung cancer alone, but if incidental findings are not acted upon in a timely way, this can leave patients vulnerable to their condition worsening.

We heard that a protocol was being developed to standardise how these incidental findings should be handled. As a collaboration of over 40 members representing the respiratory community, we wanted to make sure this protocol would serve patients appropriately.

So we hosted a roundtable in May 2024 where we brought together clinicians, patients, and those working within the TLHC programme to discuss the key issues and what this protocol should look like.

On the basis of these views of leading organisations and individuals in the respiratory sector, we identified 4 principles we want to see guide the incidental findings protocol:

1. Thresholds for the risk stratification of patients

We want clear thresholds for follow up depending on the incidental finding, its clinical significance, the severity of the finding, the potential prognosis, any required treatment, and the presence of symptoms alongside the finding. Using these thresholds, patients can be risk stratified and follow up can be selective, putting those most at need of urgent follow up at the front of the queue.

• A patient-focussed approach

The discovery of an incidental finding can cause significant worry and distress for patients. It is essential that any protocol addresses patient concerns in a timely and thorough way, with communications being delivered in a way that is accessible to each patient.

• System readiness

The protocol must minimise additional pressure on primary care services which are already overstretched; this can be achieved by maximising efficiency at the TLHC and support for the additional clinical work that will be needed to follow up incidental findings. This will require capturing of incidental findings data, potentially via an audit, to quantify the unmet need and allow for adequate resource allocation.

• The protocol needs to be backed by the appropriate resources.
  
  

The protocol must be backed by the appropriate funding for the additional work that will inevitably arise as part of the programme. With sufficient funding, the increased capacity needed for the appropriate management of these patients will be met and can be delivered to match the flow of patients through the pathway.