Lung Cancer Screening will be Hampered by Poor Recording of Searchable Smoking Terminology in GP Computer Systems

Lung cancer screening will be hampered by poor recording of searchable smoking terminology in GP computer systems

Nigel Masters retired general medical practitioner

General practice smoking records will be used to target lung cancer screening in people over 55.1 Although general practitioners generally record when patients have stopped smoking, smoking records in general practice computer systems have been inadequate for years. For example, rather than use the code ceased smoking most practices seem to use the code never smoked when a patient has stopped smoking.2 This causes confusion in the electronic summary visible to clinicians.

The number of cigarette pack years is still widely used by clinicians but has drawbacks.3 Years smoked and active smoking are the most useful terms to ascertain risk. It would be helpful for clinical work if years smoked and date ceased were visible with body mass index and blood pressure on the GP electronic summary health screen. Years smoked, however, is not yet an available code. Smoking pack years can, however, be recorded. It may be difficult to calculate in some patients, but a free calculator is available.4

The lung cancer screening programme will use the codes ex-smoking, smoking, and intensity of smoking to determine those who should be offered screening.5 These codes are not numerate but descriptive and are difficult to search. The most useful terms may be years smoked and when the patient has ceased smoking.

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.

Competing interests: NM developed the smoking pack years website with Catherine Tutt many years ago. NM pays for it himself.

1. Mahase E. Lung cancer screening for over 55s will be rolled out in England. BMJ 2023;381:. doi: 10.1136/bmj.p1469 pmid: 37369389
2. Atkinson MD, Kennedy JI, John A, Lewis KE, Lyons RA, Brophy STDEMISTIFY Research Group. Development of an algorithm for determining smoking status and behaviour over the life course from UK electronic primary care records. BMC Med Inform Decis Mak 2017;17:. doi: 10.1186/s12911-016-0400-6 pmid: 28056955
3. Pirie K, Peto R, Reeves GK, Green J, Beral VMillion Women Study Collaborators. The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet 2013;381:-41. doi: 10.1016/S0140-6736(12)61720-6 pmid: 23107252
4. Smoking pack years. www.smokingpackyears.com
5. UK National Screening Committee. New lung cancer screening roll out to detect cancer sooner. 26 June 2023. https://view-health-screening-recommenda- tions.service.gov.uk/lung-cancer.