Nurses play a key role in lung cancer screening by identifying high-risk individuals, conducting initial phone and face-to-face risk assessments, providing health education and smoking cessation support, coordinating low-dose CT scan pathways, and offering continuous emotional and clinical guidance

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 mainly 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.

Rationale behind initiating lung cancer screening:

• Leading cause of cancer death in Wales
• More deaths annually than breast and colorectal cancer combined.
• Most cases are diagnosed late when it is rarely possible to cure the disease.
• Approximately 1800 deaths per year.
• Lung cancer diagnosed at stages 1 and 2 have a better chance of cure – 55% survive the disease for 5 years or more.
• 3 % of people diagnosed in stage 3 and 4 survive the disease for 5 years or more.

For the first stage of developing the lung screening service a pilot was commenced with patients in selected GP surgeries. A lung health check and Risk assessment was undertaken.

Lung Health Check / Risk assessment:

• Involves a preliminary evaluation (phone call or nurse assessment) to review smoking history, age, and general lung health.
• Acts as the gateway to determine if someone is at high enough risk to need imaging, mobile low does CT chest scans.
• Pilots have run in specific regional areas of Wales, such as the Cwm Taf Morgannwg University Health Board in the Rhondda area.

Key pilot outcomes:

• Screened Population: Over 600 high-risk individuals in the Rhondda area participated in the pilot.
• Cancer Detections: Diagnosed 12 lung cancers, with two-thirds caught early at stage 1 or 2.
• Support Integration: Successfully embedded smoking cessation and local care pathways.
• National Impact: Proved feasibility within Wales, contributing to the Welsh Government's planned national lung screening programme.

National Lung Cancer Screening Programme in Wales:

• Announced by the Welsh Government and led by Public Health Wales, with phased rollouts scheduled to begin sending out invitations starting in 2027/28
• Targets individuals aged 55 to 74 who are current or former smokers.
• Integrates targeted smoking cessation support (such as Help Me Quit) alongside mobile low-dose CT chest scans.
• Transitions localised pilot lung health checks into a unified, nationwide public health screening service.
• The roll out will be phased and will begin with the older at-risk patients, this is the same approach that was taken with bowel screening.
• The Wales program has included financing for cardiac and respiratory issues identified during lung cancer screening.

Key documents:

• Lung Health Check Scoping Report (2019).
• Lung Health Check Operational Pilot for Wales Evaluation Report 1 (2024).
• Lung Health Check Operational Pilot for Wales Evaluation Report 2 (2025).

As Wales moves towards the implementation of a national lung cancer screening programme, there is a real opportunity to transform outcomes for one of the country's deadliest cancers.

Building on the success of the Cwm Taf Morgannwg pilot, the programme has demonstrated that targeted lung health checks and low-dose CT screening can detect cancers at an earlier, more treatable stage, when the chances of cure are significantly higher. The decision to lower the eligibility age to 55 years and deliver screening alongside smoking cessation support reflects a preventative, person-centred approach to care.

Nurses will be at the heart of this initiative, leading risk assessments, supporting informed decision-making, promoting smoking cessation, coordinating care pathways and providing ongoing clinical and emotional support.

As the phased national rollout begins, lung cancer screening has the potential not only to save lives through earlier diagnosis but also to reduce health inequalities and improve respiratory and cardiovascular health across Wales for years to come.