A radiology-led model for LDCT in Norway: the first pilot programme

This screening case study was co-developed with Professor Oluf Dimitri Røe, Specialist in Medical and Radiation Oncology at the Norwegian University of Science and Technology (NTNU).

Norway: a pioneer in lung cancer screening in Scandinavia

Evidence demonstrating the benefits of lung cancer screening has gone from strength to strength in recent years. We know now that screening programmes can play a major part in saving lives when done right – and more and more, we know what right can look like.

Through all of this, Scandinavia hasn’t quite kept pace; currently, none of the countries in this northern region of Europe have a national screening programme.¹ Practical challenges, including workforce shortages (particularly among radiologists), and the costs involved have so far prevented any screening programmes from being implemented.²

But Norway is on track to change this.

Lung cancer remains the leading cause of cancer-related deaths in Norway.³ Around one in two people diagnosed with advanced stage (IV) lung cancer ultimately find the cancer had spread, making it more difficult to treat.⁴ Diagnoses have tripled over the past 20 years, which has triggered strong public support for lung cancer screening, with 80% being in favour of implementing a programme.^{5 6}

Recognising this need, the Norwegian Cancer Control Plan 2025–2035 included the goal of introducing lung cancer screening.⁷ Estimates suggest that targeting lung cancer screening at people most at risk of developing the disease (people aged 50-79, with a risk of >1.0% of developing lung cancer over six years, according to the HUNT Lung Cancer Model (HUNT LCM)) could save nearly 7,000 lives over the next six years in Norway.^{8 9}
 

The first pilot in Norway

As a first step, in 2022, Norway rolled out a pilot programme to assess the potential impact of implementing a lung cancer screening programme and assess eligibility by different risk models.^{1 9} All people in the eligible age group were invited, by post or electronically, and those with a history of smoking (over 100 cigarettes in their lifetime) were asked to complete a risk questionnaire to determine eligibility.^{1 9}

Eligibility was restricted to residents of Akershus County aged 60–79 years who: currently smoke; or who had stopped smoking within the past 10 years and had previously smoked a pack a day for 35 years or more; or who were assessed as having a ≥2.6% risk of developing lung cancer in the next six years using the  PLCOm2012_norace  risk assessment.¹ Concurrently, all participants that were included in the screening programme and those who completed the questionnaire were assessed using two risk models, PLCOm2012_norace and the HUNT LCM, to compare the established approach with the newly developed Norwegian model.⁹

Alongside screening, smoking cessation support was provided to people who currently smoke, delivered through a 5- to 15-minute consultation.¹⁰ Participants were also offered a prescription for smoking cessation medication, reinforcing the programme’s preventive as well as its diagnostic focus.^{10 11}

At the first scan, screening led to a marked shift towards early‑stage diagnosis (where treatment can be more effective): 83% of cancers were diagnosed at stage I and 9% at stage II, while only 8% were stage III. Not a single person was diagnosed with stage IV lung cancer.¹
 

Learning from the pilot to lay the foundations for nationwide screening

Norway’s pilot programme stands out for its radiology-led model, which substantially reduced the workload for respiratory services. Radiologists were responsible for determining whether follow-up scans or biopsies were needed, meaning that respiratory physicians were involved only at a later stage.¹⁰ Radiological assessments were conducted digitally on a centralised platform, supporting more efficient working practices and laying the groundwork for scaling up.¹⁰ The pilot also used a single, validated AI system on all scans as a second reader to enhance assessment quality.¹⁰ The pilot also generated valuable evidence on eligibility criteria and risk assessment as >13 000 participants responded to questionnaires for both the HUNT LCM and the PLCOm2012_norace risk assessment models. ^{9 12} Looking ahead to a potential national programme, the optimal risk model remains under evaluation (Box 1). A large-scale study is ongoing to assess the validity and comparative performance of the PLCOm2012_norace model against the Norwegian Helseundersøkelsen i Nord-Trøndelag (HUNT) Lung Cancer Model (HUNT LCM) in the country’s specific context.^{13 14}

Norway is well placed to move towards national implementation, with several contextual factors supporting its feasibility and scalability, including:¹⁰

• a well-organised, single‑payer health system
• strong performance of existing national screening programmes, with consistently high participation rates, reflecting high levels of public trust in preventive health services
• a national digital platform (Helse Norge) that supports invitations, pre-screening risk evaluation and follow-up communications for all inhabitants of Norway¹²
• robust data linkage between population studies and national cancer registries, enabling long‑term follow‑up of smoking exposure and cancer outcomes, and supporting evidence‑informed screening design, targeting and evaluation.

Next steps for national implementation

Moving from a pilot to a national screening programme requires system‑level planning and proactive management of potential bottlenecks.¹⁰ High‑quality, robust data demonstrating effectiveness, feasibility and system impact gathered through the pilot will support decision‑making and help secure long‑term commitment.¹² Political endorsement is also essential, as programme adoption requires parliamentary approval.

At the policy level, the Ministry of Health and Care Services is considering the possibility of implementation, informed by emerging evidence and formal recommendations.¹⁰ A parliamentary vote is expected either in the autumn of 2026 or in the spring of 2027 – a decision that could make Norway the first country in Scandinavia to establish a national lung cancer screening programme. ⁹