The landscape of lung cancer screening in Wales

Leading cause of cancer death

Lung cancer is the third most common cancer in Wales but remains the leading cause of cancer death, with around 1,800 deaths each year. 

This is largely because most cases are diagnosed at a late stage when the condition is largely inoperable and where cure is rarely possible.

While two of the most common cancers in Wales, namely bowel and breast cancers, have national screening programmes aimed at earlier diagnosis, a screening programme for lung cancer has, until very recently, remained elusive.

Traditional chest X-rays, the conventional method of detecting tumours in the lung, are generally unreliable for identifying early stage and fast-growing tumours in people who have no symptoms.

CT scans and low dose radiation

Over the last decade, however, international studies have shown that targeted lung cancer screening using CT scans with low dose radiation, in past and current smokers between the ages of 55 and 74, can lead to a remarkable shift in the stage of disease at diagnosis.

In these studies, most tumours were diagnosed at stages 1 and 2, stages when lung cancer is operable and easier to treat, compared to diagnosis at stages 3 and 4 that is typical in patients who undergo tests only after symptoms have appeared.

Slow progress in Wales

Cancer Research Wales and allied charities that form the Wales Cancer Alliance have been warning for some time that progress in Wales has been slow compared to England.

On World Lung Cancer Day 2023, the Wales Cancer Alliance highlighted in an open letter that while England had already begun rolling out Targeted Lung Health Checks after successful pilots, not one person in Wales had yet benefited from lung cancer screening.

In 2022 the UK National Screening Committee recommended that all four nations implement targeted lung cancer screening using low dose CT for high-risk groups. However, Wales limited itself to a small-scale pilot study in Cwm Taf Health Board rather than committing to a full national programme.

National lung cancer screening programme

To the surprise of the study leads, several early-stage lung tumours were found in the first 500 scans, a number not initially expected to be large enough to detect any cases in an asymptomatic population. 

This result highlighted just how much a national lung cancer screening programme is needed.

Despite the success of the pilot, a national decision was not announced by Welsh Government until mid-2025, and implementation is not expected to reach patients until 2027.

Further optimisation will take several years. The UK National Screening Committee has recently revised its five-year lung cancer survival target to 35 percent by 2035. 

Achieving this will require all UK nations learning from each other and moving in the same direction, otherwise there is a clear risk of widening cancer inequalities.

Although credit must be given that Wales has now committed to a national lung cancer screening programme, even if progress has not been as fast as many would like, Scotland has yet to fully commit despite undertaking pilot studies, while progress in Northern Ireland appears even more limited.

Phased introduction

A phased introduction of lung cancer screening will help ensure an optimised programme where all CT scans are subject to careful quality control across Wales.

There is a danger that quality control could become compromised if diagnostic reporting is outsourced to different third-party companies as a way of avoiding additional pressure on an already stretched radiologist workforce. 

However, a careful approach must be balanced against the risk of too much delay, which would mean many high-risk people in Wales are not offered screening in a timely manner, ultimately resulting in avoidable deaths.

Deprivation and smoking

Lung cancer is deeply linked to deprivation and smoking, and since Wales has some of the UK’s highest deprivation levels, the burden of lung cancer falls hardest on its poorest communities. 

A well-designed screening programme with mobile units, flexible appointments and integrated stop-smoking support offers a rare chance to reduce rather than widen existing inequalities.