England’s Lung Cancer Screening Programme is for people aged 55 to 74 who have ever smoked, and the government has committed to inviting everyone eligible by 2030. That puts new weight on the smoking history held in GP records. In his 2023 BMJ letter, Dr Nigel Masters argued that poor smoking records in GP computer systems would hamper screening.
What is England’s lung screening rollout?
The Department of Health and Social Care announced the national roll-out on 26 June 2023. It said the programme would “use patient’s GP records for those aged 55 to 74 to identify current or former smokers”.
The National Cancer Plan for England, published on 4 February 2026, commits to completing the roll-out by 2030, “meaning every eligible person in England will have received their first invitation for a check”. The plan reports that over 1.5 million people have attended a lung health check and over 9,000 have been diagnosed with lung cancer, 76% of them at stage 1 or 2.
Under NHS England’s standard protocol for the programme (version 3, February 2025), a lung health check is for people who are aged between 55 and 74, are registered with a GP practice in England and “have ever smoked”. Our page on how lung cancer screening works in England sets out each step.
What did Dr Masters argue in his 2023 BMJ letter?
Writing in response to the BMJ’s news report of the roll-out, Dr Masters argued that lung cancer screening will be hampered by poor recording of searchable smoking terminology in GP computer systems (BMJ 2023;382:p1892). Among his points:
- Smoking records in general practice computer systems “have been inadequate for years”. For example, he wrote, “rather than use the code ceased smoking most practices seem to use the code never smoked when a patient has stopped smoking.”
- The smoking codes “are not numerate but descriptive and are difficult to search.”
- “Years smoked and active smoking are the most useful terms to ascertain risk.” Yet “Years smoked, however, is not yet an available code”, while pack years can be recorded.
He ended: “Perhaps, at last, this screening programme will show the poor quality of smoking records because of inadequate and poor software choices in general practice computer systems.” The two measures are compared in pack years and years smoked: why record both?
What does the screening protocol say about smoking records?
The published protocol acknowledges the same weakness. Paragraph 3.1.1 says that “Due to the poor quality of smoking record data”, everyone aged 55 to 74 should be given the opportunity to take part by the time national roll-out is complete, “irrespective of their existing recorded history of smoking”. This is so that no one potentially eligible is missed, although more ineligible people will be contacted.
The protocol also says that GP or site records should be re-queried at least every two years to decide who to invite, that each participant’s risk score and the “components of medical history used to determine risk scores” must be clearly recorded, and that SNOMED codes should be used to record the participant’s journey and outcomes on their GP record. As FAQ 2 on this site explains, smoking in NHS records is documented by SNOMED CT code descriptors, such as “ex-moderate smoker (10-19/day)”, and smoking duration cannot be coded as a number.
Is the decision to scan based on pack years?
No. Whether someone is offered a low-dose CT scan is decided at the lung health check, using two risk models. The protocol’s thresholds are a PLCOm2012 risk of 1.51% or more over six years, or an LLPv2 risk of 2.5% or more over five years, and meeting either one is enough. The threshold is a risk score, not a number of pack years.
The smoking details the two models use are listed in the protocol’s Table 2. LLPv2 uses smoking duration in years. PLCOm2012 uses smoking status, the average number of cigarettes smoked per day, duration smoked in years and years since stopping. Neither model takes pack years as an input, although a pack-year figure is built from two of the same ingredients: cigarettes a day and years smoked. In his letter, Dr Masters wrote that “The most useful terms may be years smoked and when the patient has ceased smoking.”
What can practices and patients do now?
The site’s FAQs, prepared by Dr Masters and Catherine Tutt, recommend that “starting and stopping dates, smoking duration in years and smoking pack years should be recorded for each patient”. FAQ 2 adds that this numerical recording “would also be helpful in smoking related disease screening”.
The calculator follows that advice. As well as pack years, its optional history step records whether someone still smokes, when they stopped and how many years they smoked in total. The version for clinicians puts all of this in one line to paste into the record. Patients preparing for a check can use the lung health check calculator and our guide to working out your smoking history. The figures are for information: the lung health check team asks its own questions and decides what happens next.
To work out a smoking history in pack years, together with years smoked and the date stopped, use the free smoking pack year calculator.