• NHS Targeted Lung Health Checks (TLHC) are rolling out across the country, giving people the opportunity to have their lung health looked at free of charge and have treatment early if any problems are found. Most people will have no problems, but it is best to get checked out.

• The TLHC Programme identifies people aged 55-74 at increased risk of lung cancer. We invite them for a telephone lung health check assessment and chest CT scan if appropriate which will take place in a mobile unit setting.

• In June 2023 the Prime Minister announced that the targeted lung health check programme (TLHC) would become a National Screening Programme in England.

• The programme started in 2019 after a study showed CT screening reduced the number of people dying of lung cancer by 26% in men and between 39% and 61% in women.

• The NHS is working to increase the number of people who survive cancer by finding it earlier, when it is easier to treat.

• Lung cancer is often diagnosed at a late stage because symptoms are not always noticed until the disease has become worse. Lung health checks are successful in finding cancer in its first stages, when people are much more likely to be cured by treatment.

• Cheshire and Merseyside led the way in rolling out lung health checks and they have already taken place in areas where lung cancer is more common – Liverpool, Knowsley, Halton, St Helens and south Sefton – and will be in Wirral, Warrington and north Sefton during 2024 and 2025. They will eventually take place in all areas of Cheshire and Merseyside.

• Watch this video about why having a check is important: https://www.youtube.com/watch?v=BrvIX4jQgwE

• If you are aged 55 to 74 and you smoke, or have previously smoked, you will be sent an appointment to a lung health check when we are live in your area and when it is your turn. It will arrive in a text message or posted letter. This appointment will take place via telephone with a member of the TLHC team who are specialised in delivering a lung health check assessment.

• If you have not been invited for a lung health check and believe that you are eligible, please contact the TLHC team on 0151 254 3032.

• It is important that your GP surgery knows your history of smoking and that it is noted correctly in your NHS records so that you receive a lung health check appointment. If you are not sure if it is noted correctly, please check with your GP surgery.

• The lung health check takes place on the telephone and takes about 30 minutes to complete. You will be asked a series of questions about your health and lifestyle including any personal or family history of lung cancer, and if you are a current or former smoker. The answers are used to assess your risk of developing lung cancer.

• If you are assessed as being at an increased risk of lung cancer, you will be offered a low dose CT scan, a type of X-ray which takes an image of your lungs. If you are offered a scan, and you will be talked through the benefits and risks of it and you will have the opportunity to ask any questions you may have. An appointment for your CT scan will be booked.

• Your scan is simple and quick will take place in a mobile unit near to where you live. About four weeks after your scan, you will receive your results and your GP will also be told about them. The vast majority of people are totally fine, and their lungs are completely healthy.

• Watch this video for more information about lung health check CT scans: https://www.youtube.com/watch?v=T2qAsNUfg0I

• Liverpool Heart and Chest Hospital is the Lead Provider and is responsible for delivering the TLHC Programme across the Cheshire and Merseyside region working in partnership with the Cheshire and Merseyside Cancer Alliance and local NHS teams.

Find out more about lung health checks here: https://roycastle.org/lung-health-checks/

Watch these videos about lung health checks:

• Dennis’s story: https://youtu.be/lz0EFBOfDrQ
• Naheed’s story: https://youtu.be/ghtlrS3v_FI
• Terry’s story: https://youtu.be/wD_CPx9tevw

Lung health checks near you: Liverpool

• To find out more about keeping your lungs healthy in Liverpool, see our guide: https://www.lhch.nhs.uk/media/.resources/64abf8d923c790.25998601.pdf
• Still smoking but would like help and support to stop in south Sefton? The best thing you can do to keep your lungs as healthy as possible is to stop smoking.
• Contact Smoke Free Sefton for help and support to stop smoking. The Smokefree Liverpool website address is: www.smokefreeliverpool.co.uk

Lung health checks near you: Knowsley

• To find out more about keeping your lungs healthy in Knowsley, see our guide: https://www.lhch.nhs.uk/media/.resources/64abf8d923c790.25998601.pdf

Lung health checks near you: Halton

• To find out more about keeping your lungs healthy in Halton, see our guide: https://www.lhch.nhs.uk/media/.resources/64abf8d923c790.25998601.pdf

Lung health checks near you: St Helens

• To find out more about keeping your lungs healthy in Halton, see our guide:
• https://cmcanceralliance.nhs.uk/application/files/8716/7119/0898/TLHC_-_Booklet_-_St_Helens.pdf
• Still smoking but would like help and support to stop in St Helens? The best thing you can do to keep your lungs as healthy as possible is to stop smoking.
• Contact the St Helens Wellbeing Stop Smoking service for help and support to stop smoking, available free of charge.
• For more information or to make an appointment text QUIT to 61825 or call 01744 371 111 or visit them online here: www.sthelenswellbeing.org.uk/services/stop-smoking

Lung health checks near you: south Sefton

• To find out more about keeping your lungs healthy in south Sefton, see our guide: https://cmcanceralliance.nhs.uk/application/files/2916/7119/0919/TLHC_-_Booklet_-_South_Sefton.pdf
• Still smoking but would like help and support to stop in south Sefton? The best thing you can do to keep your lungs as healthy as possible is to stop smoking.
• Contact Smoke Free Sefton for help and support to stop smoking, available free of charge.
• For more information or to make an appointment, call Smoke Free Sefton on 0300 100 1000 or visit them online here: www.smokefreesefton.co.uk

Lung health checks near you: north Sefton

• Still smoking but would like help and support to stop in north Sefton? The best thing you can do to keep your lungs as healthy as possible is to stop smoking.
• Contact Smoke Free Sefton to get help and support to stop smoking, available free of charge.
• For more information or to make an appointment, call Smoke Free Sefton on 0300 100 1000 or visit them online here: www.smokefreesefton.co.uk

Your lungs work hard every day so you can breathe. They don’t get much rest because in one day you can breathe up to 25,000 times. They carry oxygen from the air to your blood and release carbon dioxide from your blood into the air. Your body’s cells need this oxygen to work properly.

Your lungs have a natural defence system to keep out dirt and germs, but several things can damage this, meaning they can’t do their job as well.

There are things you can do to look after your lungs – which is especially important if you have a lung condition – including:

• stopping smoking
• being more active
• having a healthy diet
• making sure you have all your vaccinations if you are over 65 or have a long-term condition
• knowing the warning signs and symptoms of lung conditions, including Chronic Obstructive Pulmonary Diseases (COPD) and lung cancer.

Contact your GP surgery if you are worried about symptoms of lung cancer, such as:

• a cough that does not go away after three weeks
• an existing cough that changes or gets worse
• chest infections that keep coming back
• coughing up blood
• being short of breath a lot
• unexplained tiredness
• an ache or pain when breathing or coughing
• loss of appetite or unexplained weight loss.

**Do not wait for a lung health check if you have any of these symptoms, make an appointment with your GP practice.**

What is the Targeted Lung Health Checks (TLHC) programme?

• It is the pilot of a new service for those aged 55 to 74 who have ever smoked. It is a process with two stages. There is an initial conversation with a health professional, then, if needed, the second stage is a simple CT scan, which can identify signs of cancer at an early stage when it is much more treatable. The programme started in 2019 and is now being extended to more areas of the country, with further areas added over time. In Cheshire and Merseyside TLHC initially started in Liverpool, Halton and Knowsley, St Helens, south Sefton and is now expanding Wirral, Warrington and north Sefton.

What is the aim of the programme?

• The aim is to detect lung cancer and disease early so people can be treated sooner and more effectively - ultimately saving more lives.
• Lung cancer often has no symptoms in the earlier stages which can result in it not being found until the later stages when outcomes are less favourable.

How does the NHS choose which areas will take part in the programme?

• From data on the number of smokers in each area and incidence of lung cancer. Areas with the highest smoking and lung cancer rates have been chosen for the checks as this will have the biggest impact.

What is the patient needs more information?

• They should be directed to the local TLHC programme webpage: https://www.lhch.nhs.uk/lung-health-check/

Who are doing the lung health checks/ scans?

• Liverpool Heart and Chest Hospital is carrying out the lung health checks over the phone. The CT scans take place in a mobile scanning unit which will come around different areas of your borough over the next year or so. The scanner will be situated in a central location within your community.

I'm under 55. Why can't I have a lung health check?

• Currently, lung health checks are for people aged 55-74 who have ever smoked. Lung health checks are proven to be beneficial in medical research in this age group. Below this age we do not have enough evidence that we can achieve definite benefit. However, anyone can get lung cancer so if you have any concerns or are experiencing symptoms, contact your GP immediately.

Why are lung checks only available to people who have smoked?

• Currently, lung health checks are for people aged 55-74 who have ever smoked. This is because they are at a higher risk of lung disease or lung cancer than people who have never smoked. However, anyone can get lung cancer so if you have any concerns or are experiencing symptoms, contact your GP immediately.

I've quit smoking so why do I need to go?

• Well done for successfully quitting smoking. In doing so, you have reduced your risk of getting lung cancer. However, you still have a higher risk of lung cancer than someone who has never smoked, so you should still go for the check.

I'm over 74. Why can't I have a lung health check?

• Currently, lung health checks are for people aged 55-74 who have ever smoked. Lung health checks are proven to be beneficial in medical research in this age group. Above this age we do not have enough evidence that we can achieve definite benefit. The main concern is that the risks from treatment and other medical conditions begin to outweigh the benefits of screening from 75 years and over. However, anyone can get lung cancer so if you have any concerns or are experiencing symptoms, contact your GP immediately.

Why are lung health checks not offered to people who have experienced passive smoking?

• Currently, lung health checks are for people aged 55-74 who have ever smoked. This is because they are at a higher risk of lung disease or lung cancer than people who have never smoked. This is based on medical research. Research to show benefits in other settings, such as those who have never smoked, have smoked low amounts, or who have experienced passive smoking, is not yet available. However, anyone can get lung cancer so if you have any concerns or are experiencing symptoms, contact your GP immediately.

Why are CT scans only offered to some people who get a lung health check?

• Currently, lung health checks are for people aged 55-74 who have ever smoked. The lung health check appointment will identify people who have a higher risk of lung cancer and they will then be offered a low dose CT scan. Medical research has shown us that people who meet this risk threshold are most likely to benefit from a CT scan because lung cancer may be found early. For people who do not meet the risk threshold, we do not have enough evidence that they will benefit, compared to the potential harms of having a CT scan. However, anyone can get lung cancer so if you have symptoms that are worrying you, contact your GP immediately.

I'm scared about what they might find at the appointment

• It's completely understandable that you might be a little nervous about having a lung health check but it is really important that you go. You can request that someone comes with you to the appointment, such as a family member or friend. Chances are everything will be ok but if it is lung cancer, catching it early can make all the difference.

There's a history of lung cancer in my family so can I be tested?

• Currently, lung health checks are for people aged 55-74 who have ever smoked. This is because they are at a higher risk of getting lung cancer.
• There is currently no proof from medical research that an inherited risk of cancer alone can reliably inform who is more at risk of having lung cancer. Smoking history is proven to be the best measure for identifying who should have a lung check because former/current smokers are more likely to develop lung cancer. However, we do take family history into account in the lung health check risk assessment.

What happens at the check?

• You will receive an invitation to a lung health check by text message. You must access the link to confirm your appointment.
• Your appointment will be by phone. A health professional/nurse will ask about your health and lifestyle to find out more about your risk of developing lung cancer. If the lung health check finds you're at a higher risk of developing lung cancer, you may be invited for a low dose CT scan.
• This is very common and is not necessarily a cause for concern. Your CT scan will be done in a mobile CT unit within the community. You will receive a letter or call within 4 weeks of the scan as well as a letter sent by the team to you and your GP.

What happens at the CT scan?

• A CT scan takes a detailed picture of your lungs and checks for any signs of lung cancer or lung disease. During the scan, the bed moves in and out of the scanner. Your head and legs stay outside of the scanner and you do not go into an enclosed space. The scan is done in either a mobile scanning unit in your local area, or at a local hospital, to make it as easy as possible for you to get to. It only takes a few minutes and does not hurt. You can also bring a friend or relative with you for support.

When will I receive my results?

• You will receive a letter or a call with your results within 4 weeks of the
• CT scan. This will tell you what happens next. If the scan shows anything concerning, you may be referred for further lung scans or treatment.
• Around 15 out of every 100 people screened have nodules on their lungs.
• Most nodules are harmless and caused by something else like scarring from a previous chest infection. Around 1 in 100 people who go for a CT scan are diagnosed with lung cancer. If the scan shows nothing of concern, you will be invited back for another scan every two years until you are 75.

Who cannot have a scan?

• There are a number of reasons why a patient might not be offered a low dose CT scan and these include: the patient has had a CT scan in the last 12 months; they're unable to lie flat; they're unable to transfer onto the CT scanning bed without support, or with the support of somebody who attends the scan with them; they weigh more than 200kg/31.5 stones; they are not physically fit; they do not have capacity to consent to the CT scan and it is not in their best interests to have one.

Can I bring someone along to the scan?

• Yes, this may be possible. Patients should ask the TLHC team for further information. Contact details will be in their invitation letter or text link.

When will the Targeted Lung Health Check (TLHC) programme be in my area?

Targeted Lung Health Check (TLHC) Programme Roll Out Plan

Practices are being contacted by their local Place/ICB on a rolling programme to get ready for sending eligible patient demographics (aged 55-74 and ever smoked) to Liverpool Heart and Chest Hospital (LHCH), the commissioned provider delivering lung health checks and low dose CT scans for the TLHC Programme.  More info about the programme here.  This process happens around 3-4 months before your patients start to be invited for screening, so please continue to respond to these direct communications as you receive them.

Liverpool Heart and Chest Hospital will then coordinate sending of patient invite letters as per the schedule below.

Please click on the image below to view a table showing the high-level dates for when the TLHC programme will be live in the areas of Halton, Knowsley and Liverpool Places:

Table updated as at 06/10/22

Next steps after the programme has finished in your area:

Please be aware that the TLHC team will book follow up scans for those with lung nodules identified on CT (3- or 12-month repeats), and also a 24 month repeat scan for those with normal/no significant CT findings on the first scan as per national protocol.

Scan findings: Actions required by General Practice and actions undertaken by LHCH – i.e. the clinical pathway

The following attachment shows the clinical pathway for the TLHC programme.

LHCH will review all CT results. This will be in line with their standard MDT protocols, and where appropriate, cases will be discussed by the Low Dose CT MDT. LHCH will action all significant abnormal CT findings, including lung cancer and lung nodules onward referral.  The only CT findings to be passed back to GP Practices will be non-urgent incidental CT scan findings, and LHCH will provide advice to Practices.    CT reports will be available to Practices via the EMIS shared record, and Practices will also receive a letter from the TLHC team.   

How to book a TLHC inflammatory consolidation follow up CT 

As the patient’s GP you will receive a letter asking you to arrange a follow up Chest CT at 3 months.

On receipt of this letter, the GP should request this using RLUH ICE.

(Radiology for appropriate site > CT tab >GP CT Lung Health check f/up)

Please be prepared to enter the date the CT is due.

The patient will have been told by the TLHC nurse that the follow up will be arranged in 3m.

Radiology will contact the patient directly re appointment nearer the time.

The GP is responsible for booking the CT and actioning this CT result. Please consider practice safety netting.

Any queries re TLHC:

Tel: 0151 254 3032 (9-5 Mon Fri excl. bank hols)

Email: tcc-tr.lunghealthchecklhch@nhs.net

Website: https://www.lhch.nhs.uk/our-services/lung-health-check/

THLC consolidation Pathway for information

Patient has at CT as part of the Targeted Lung Health Check Programme (TLHC) which shows

Consolidation which appears inflammatory.

1. TLHC Nurse telephones the patient to advise the patient to contact GP/111/AED for review and appropriate treatment.
2. THLC nurse informs GP by letter and TLHC admin rings the GP surgery.
3. The CT is discussed at TLHC MDT.
4. After TLHC MDT, the THLC nurse sends ‘GP Consolidation outcome letter’ via EMIS direct messaging.
5. GP to order follow up CT for 3 months as above.

Oct 2021 review Oct 2022

Cancerteam@liverpoolccg.nhs.uk

LUNG HEALTH CHECK PROJECT TEAM letter will say:

ICE  > Radiology >GP CT > GP Lung health check f/up GP, the attached leaflet is linked to the ICE Request.

Coronary Artery Calcification Advice and Guidance

If the patient is known to have coronary artery disease (previous myocardial infarction, abnormal coronary angiogram, coronary angioplasty or stenting or coronary artery bypass grafting) and is already taking secondary preventative measures, no further action is necessary.

If the patient has no prior diagnosis of coronary artery disease, they should be offered an appointment in primary care to discuss any symptoms and review their risk factors for coronary artery disease.

1. Asymptomatic with mild/moderate calcification

Coronary artery calcification indicates established atherosclerotic coronary artery disease, though it may not be causing any obstruction to blood flow. In these patients the mainstay of treatment is medical. Asymptomatic patients with mild or moderate coronary calcification should have their risk factors treated according to standard primary prevention guidelines (NICE CG 181).

2. Asymptomatic with severe calcification

If the calcification is described as severe, we would recommend using secondary prevention guidelines and targets, starting atorvastatin 80mg and aspirin 75mg. Consider beta-blockers and ACE-inhibitors to control blood pressure. Referral is not required to secondary care so long as the patient has reasonable exercise tolerance and is asymptomatic. Patients whose exercise tolerance is significantly limited for any reason should be referred for further assessment.

3. Symptomatic patients

Patients with symptoms of exertional chest discomfort should be referred for a routine cardiology clinic appointment through ERS, unless they have recent (within the last six weeks) onset of symptoms, or rapidly worsening symptoms, in which case they should be referred to a rapid-access chest pain clinic. All symptomatic patient should be started on aspirin 75mg OD, atorvastatin 80mg, bisoprolol 2.5mg OD and GTN spray PRN (unless there are contra-indications) and given safety-netting advice about action to take in the event of unexpected or prolonged chest pain.

Patients who would not be fit for cardiac surgery because of severe comorbidity or other life-limiting diagnoses need not be referred for assessment.

Previous Coronary Artery Calcification Advice and Guidance is archived for GPs here.