# Publish the four numbers the NHS lung cancer pathway does not currently measure: reflex testing rate, genomic turnaround, surgical access and a lung-specific waiting time in every nation

Source: https://onco.cc/ideas/idea-lung-uk-screening-testing-and-access-gaps/  
OnCo record `idea-lung-uk-screening-testing-and-access-gaps` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Every targeted result on this roadmap depends on a test happening fast enough to act on. In England nobody publishes what share of lung cancers are tested, how long the test takes, or, in Wales and Northern Ireland, how long the lung pathway takes at all.

## Summary

The United Kingdom and NHS page for lung cancer set out to record what the NHS delivers against what the evidence says, and four of its findings are absences rather than figures.

The first is the reflex testing rate. A full-text search of the National Lung Cancer Audit's State of the Nation 2026 report for EGFR, ALK, ROS1, PD-L1, molecular, genomic and biomarker returns a single hit, in a recommendation asking trusts to ensure molecular pathology capacity. No published figure says what proportion of English lung cancer patients receive the testing NICE NG122 requires before treatment.

The second is turnaround. The National Genomic Test Directory has no turnaround column, and NHS England's genomic testing activity release says waiting-time data is planned for a future publication. The newest figures anyone can quote are from the 2019 GIRFT and audit organisational survey and an audit spotlight on people diagnosed in 2017.

The third is who gets an operation. No NHS England document names the thoracic surgery centres: service specification 170016/S sets the volume rules and says there were 29 units in England when it was written, lists none of them, and has not been refreshed since July 2017. The centre list on the UK page is assembled from the audit's resection counts instead.

The fourth is time. Wales reports its suspected cancer pathway for all cancers together, with no lung-specific figure; Northern Ireland publishes no 28-day faster diagnosis standard and splits lung out only for the 31-day one.

The proposal is that the four be published, on the same cycle as the audit, so that the pathway can be measured where it actually breaks.

## Fields

- Kind: Idea
- Last checked: 2026-09-25
- Tags: lung-evidence
- Hypothesis: Publishing reflex molecular testing rates, genomic turnaround times, named thoracic surgery centres and a lung-specific waiting time for all four nations would show variation between trusts and nations large enough to explain part of the treatment gap the same audit already measures by deprivation, and would move it, as publishing surgical resection rates did.
- Rationale: The audit already measures the outcomes these four inputs decide: the proportion given treatment with curative intent, the proportion having surgery, and the time from diagnosis to treatment. It does not measure the inputs. A target-driven drug on this roadmap is worthless to a patient whose tumour was never genotyped, and no one can say how often that happens. The precedent is the audit's own surgical resection rate, which was published, varied, and then rose.
- Proposed test: Add three fields to the National Lung Cancer Audit's annual return (was a molecular panel requested, when was the result available, and which alterations were tested) and one to the NHS England genomic testing activity release (request to report turnaround by test and by laboratory hub); refresh service specification 170016/S with the units it governs; and have Wales and Northern Ireland report lung separately against the same standards England uses. Success is that each figure exists, is broken down by trust or health board, and can be put beside the audit's curative-intent and surgery rates.
- Maturity: speculative
- Actor: policy

## Connected records

- ideas: [Take lung screening scanners to supermarket car parks in the poorest areas](https://onco.cc/ideas/idea-prev-mobile-lung-screening-deprived-areas/)
- roadmaps: [Diagnostics roadmap: stains → gene panels → blood tests that decide treatment](https://onco.cc/roadmaps/diagnostics-roadmap/), [Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch](https://onco.cc/roadmaps/lung-cancer-evidence-roadmap/)
- cancers: [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Small-cell lung cancer](https://onco.cc/cancers/sclc/)
- fronts: [Diagnostics & Biomarkers](https://onco.cc/fronts/diagnostics/), [Early Detection & Screening](https://onco.cc/fronts/early-detection/)
- terms: [Next-generation sequencing (NGS)](https://onco.cc/terms/ngs/)
- technologies: [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/)
- institutions: [National Institute for Health and Care Excellence](https://onco.cc/institutions/nice/)
- bottlenecks: [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [Not enough oncologists, nurses, pathologists, physicists](https://onco.cc/bottlenecks/b-workforce/), [Prices and value](https://onco.cc/bottlenecks/b-drug-pricing/), [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/)
- key papers: [Genotypic and histological evolution of lung cancers acquiring resistance to EGFR inhibitors](https://onco.cc/key-papers/paper-sequist-genotypic-histological-evolution-egfr-resistance-sci-transl-med-2011/), [Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement](https://onco.cc/key-papers/paper-uspstf-lung-cancer-screening-jama-2021/), [Socioeconomic inequalities in lung cancer treatment: systematic review and meta-analysis](https://onco.cc/key-papers/paper-forrest-socioeconomic-inequalities-lung-cancer-treatment-plos-med-2013/)

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