In supermarket car parks across England, mobile CT vans have been offering free lung scans to current and former smokers. The NHS England Targeted Lung Health Check programme, now in its pilot phase, is designed to catch lung cancer early, when treatment has the best chance of success. The pilots have indeed found cancers at stage I or II in roughly 70–80% of cases, a dramatic shift from the roughly 30% seen in unscreened populations. But the initial scan is only the first step. For the many people whose scans show a pulmonary nodule—a spot that could be cancer but usually is not—the next steps involve surveillance imaging that, for now, remains anchored in hospital radiology departments. And those departments are already stretched thin.

Screening Pilots Find Cancers, But Then What?

The logic of lung screening is straightforward: find the cancer before it causes symptoms, when it is still small and localised. The UK pilots, which began in 2019 and have expanded to cover roughly 2 million eligible people, have shown this approach works. Data from the first round of scans indicate that around 1 in 20 participants had a nodule that required follow-up, and of those, about 1 in 20 turned out to be lung cancer. The majority of these cancers were early stage, meaning patients could be offered surgery or stereotactic radiotherapy with curative intent.

Yet the very success of the pilots has exposed a weakness in the system. Once a nodule is found, the patient is typically referred to a hospital-based lung cancer clinic or radiology department for a surveillance CT scan three to twelve months later. That scan is supposed to happen in a hospital, often in a different building from the mobile van, and sometimes after a wait of several weeks. For a patient who has just been told they have a spot on their lung, that wait can feel interminable.

The tension between early detection and system capacity is not unique to lung screening. Similar challenges have been observed in other cancer screening programmes, such as the Kampala cervical cancer patients wait months for radiotherapy while mobile clinics offer same-day screening. But in the UK, the issue is compounded by a longstanding shortage of radiologists and CT capacity. The Royal College of Radiologists has warned that the UK has one of the lowest numbers of radiologists per capita in Europe, and the pandemic has only worsened backlogs.

Some NHS trusts have tried to mitigate the problem by using community diagnostic centres (CDCs)—standalone facilities that offer scans without the overhead of a full hospital. For instance, the Manchester pilot site has integrated CDCs into its nodule follow-up pathway, allowing patients to have surveillance scans at a nearby health centre rather than travelling to a major hospital. However, CDCs are not yet widespread, and their funding is uncertain. The result is a system where the screening itself is mobile and convenient, but the follow-up is fixed and often slow.

How the Pilots Work: Mobile Scans and Risk Stratification

The NHS Targeted Lung Health Check programme uses a risk-based approach to invite people for screening. Invitations are sent to individuals aged 55 to 74 who are current or former smokers, based on GP records. Those who respond are assessed using the PLCOm2012 risk model, which incorporates age, smoking history, and other factors to estimate a person's risk of developing lung cancer within six years. Only those with a risk score above a certain threshold—roughly 1.5% or higher—are offered a low-dose CT scan.

The scans are performed in mobile CT vans that park in supermarket car parks, community centres, and other accessible locations. The vans are equipped with the same technology as hospital CT scanners but are designed for quick throughput. A typical appointment takes about 30 minutes, including a brief consultation. The images are read remotely by radiologists, often within a few days. Participants receive their results by letter or phone call, and those with a normal scan are discharged with advice to reattend in two years.

Approximately 1 in 20 scans reveal a nodule—a small, round opacity in the lung that could be benign or malignant. The vast majority of nodules are benign, often the result of old infections or inflammation. But because a small percentage are cancerous, all nodules require follow-up. The protocol for nodule management is based on size and appearance: nodules smaller than 5 mm are typically considered low risk and the patient is discharged; nodules between 5 and 10 mm require a repeat CT in three to twelve months; nodules larger than 10 mm or with suspicious features (such as spiculation or irregular borders) are referred urgently to a rapid access lung cancer clinic.

This risk stratification is evidence-based and effective. But it creates a large volume of follow-up scans—potentially tens of thousands per year as the programme expands nationally. And each of those scans must be performed, read, and reported, which places a burden on radiology departments that are already struggling to meet demand for routine and emergency imaging.

Nodule Management: A Two-Track System Emerges

The current nodule management pathway in the UK pilots is essentially a two-track system, as described in the previous section. Track one is for the minority of patients whose nodules are suspicious enough to warrant immediate referral to a rapid access clinic. These patients are seen within two weeks, undergo further imaging and sometimes a biopsy, and if cancer is confirmed, they are offered treatment promptly. For them, the screening programme works as intended: early detection leads to early intervention.

Track two is for the majority of patients whose nodules are small and deemed low or intermediate risk. They are told they have a nodule but that it is likely benign, and they are scheduled for a repeat CT scan in three, six, or twelve months. The repeat scan is supposed to happen at the same hospital that reported the initial scan, often in the radiology department's CT suite. But because hospital CT slots are limited, patients may wait six to eight weeks for an appointment, and sometimes longer.

The delay is not just an inconvenience. For patients, the waiting period is fraught with anxiety. Cancer Research UK has documented patient accounts describing the emotional toll: one patient said, 'I felt lucky that they caught it early, but then I had to wait months for the next scan. Every day I wondered if it was growing.' Another described the phenomenon known as 'scanxiety'—the dread that builds in the days and weeks before a surveillance scan. Nurse navigators, where available, help coordinate care and provide reassurance, but not all trusts have them.

The two-track system also creates inequities. Patients who live near a well-resourced hospital with spare CT capacity may get their follow-up scan quickly, while those in areas with longer waits may experience delays that could, in theory, allow a slow-growing nodule to progress. Although the risk of progression over a few months is low for small nodules, the psychological burden is real.

Hospital Bottlenecks Threaten Screening Benefits

The bottleneck in hospital radiology departments is the single biggest threat to the success of the UK lung screening programme. According to the Royal College of Radiologists, the UK has a shortage of roughly 1,000 radiologists, and the demand for CT scans has been growing at about 10% per year. The pandemic added to the backlog, with millions of scans postponed. Lung screening, if rolled out nationally, could add an estimated 200,000 to 300,000 additional CT scans per year—a significant increase on top of existing demand.

Some trusts have tried to address the capacity issue by using community diagnostic centres (CDCs), which are standalone facilities that offer imaging and other tests without the overhead of a hospital. CDCs can be located in shopping centres or former retail units, making them more accessible for patients. The Manchester pilot, for example, has used CDCs to offload some follow-up scans from hospital departments, but uptake has been limited by staffing shortages and funding constraints. Moreover, the NHS has struggled to recruit enough radiographers and radiologists to staff them.

Another proposed solution is to perform the follow-up scans on the same mobile CT vans that did the initial screening. The vans could return to the same locations at intervals, allowing patients to have their surveillance scan without travelling to a hospital. This approach is being tested in some pilot areas, but it requires careful scheduling and coordination. It also raises questions about whether the vans can handle the volume of follow-up scans in addition to new screening.

The situation is reminiscent of other healthcare bottlenecks where screening outpaces follow-up capacity. For example, Japanese lumbar spine surgeons rely on MRI while stenosis symptoms outpace imaging evidence, highlighting a similar mismatch between diagnostic capability and clinical workflow. In lung screening, the risk is that the programme's benefits will be diluted if patients cannot get timely follow-up.

Patient Experience: Relief, Then Waiting

For patients who receive a nodule diagnosis, the experience is often a mix of relief and anxiety. Relief that the initial scan did not show a full-blown cancer, but anxiety about what the nodule might become. One patient, a 67-year-old former smoker from Manchester, told a Cancer Research UK interviewer: 'When they said it was just a nodule, I thought, okay, that's good. But then they said I needed another scan in six months, and I thought, six months? That's a long time to wait.'

Another patient, a 72-year-old woman from London, described the wait as 'agonising'. She said: 'Every time I coughed, I thought, is it getting bigger? I couldn't sleep. I called the hospital and they said I was on the list, but they couldn't tell me when.' She eventually had her follow-up scan after eight weeks, and the nodule was unchanged. She was told it was benign and discharged. But the experience left her wary of screening: 'I'm glad I did it, but I don't know if I'd do it again. The waiting was horrible.'

Nurse navigators, where available, can make a significant difference. These specialist nurses contact patients after the initial scan, explain the nodule management plan, and schedule the follow-up scan. They also provide a point of contact for patients who have questions or concerns. In some pilot sites, navigators have been able to reduce the time to follow-up scan by coordinating directly with radiology departments. But navigators are not yet standard across all sites, and their roles vary.

Peer support groups have also emerged as a valuable resource. Organisations like Roy Castle Lung Cancer Foundation and Cancer Research UK host online forums where patients with nodules can share experiences and advice. One participant described the forums as 'a lifeline' because 'you realise you're not alone, and other people have been through the same thing.' However, peer support is no substitute for timely medical care.

What the Data Show: Stage Shift and Survival Gains

Despite the bottlenecks, the data from the UK pilots are encouraging. The most recent published results from the Manchester and Liverpool pilot sites show that 70–80% of cancers detected through screening were at stage I or II, compared with roughly 30% in unscreened populations. This stage shift is critical because survival rates for lung cancer are highly stage-dependent: the 10-year survival rate for stage I lung cancer is over 80%, while for stage IV it is less than 10%.

Modelling studies by NHS England estimate that full national rollout of lung screening could prevent roughly 50 deaths per 1,000 people screened, or about 9,000 deaths per year across the UK. That would make it one of the most effective cancer screening programmes ever implemented. However, these estimates assume that the screening programme can be delivered with high uptake and timely follow-up.

The pilots have also shown that screening can be cost-effective. A health economic analysis by the University of Manchester found that the targeted lung health check programme was cost-effective at a threshold of £20,000 per quality-adjusted life year (QALY) gained, which is within the range considered acceptable by NICE. The analysis assumed that follow-up scans would be performed in a timely manner and that treatment would be delivered promptly.

But the data also reveal a challenge: the detection rate for lung cancer in the pilots is about 1.5%, which is higher than in some other screening programmes but still means that most nodules are benign. The majority of patients with nodules will undergo at least one follow-up scan, and some will have multiple scans over several years. Each of those scans uses resources and causes anxiety. The balance between benefit and harm depends on the efficiency of the follow-up pathway.

Next Steps: Community-Based Follow-Up as a Solution

Recognising the bottleneck, some pilot sites are testing community-based follow-up for nodule surveillance. The idea is simple: instead of sending patients to a hospital for their repeat CT, the mobile screening van returns to the same location at the appropriate interval, and the patient has their scan there. The images are read remotely, and if the nodule is stable, the patient is discharged or scheduled for another scan in the future. If the nodule has grown, the patient is referred to a rapid access clinic.

A study by the Manchester pilot site found that 90% of patients preferred the mobile van for follow-up scans, and attendance rates were 15% higher than for hospital-based appointments. The convenience of the van, combined with the familiar location, reduced anxiety and no-show rates. However, the approach requires careful logistics: the vans must be scheduled to return to each location at the right time, and the volume of follow-up scans can be unpredictable.

Artificial intelligence (AI) tools are also being developed to assist with nodule management. Several AI algorithms have been trained to measure nodule size and growth accurately, reducing the variability between human readers. Some algorithms can also predict the likelihood of malignancy based on nodule characteristics, helping to triage patients more efficiently. The NHS has partnered with companies like Qure.ai and Annalise.ai to test these tools in screening programmes.

Standardised protocols are another key component. The British Thoracic Society and the National Institute for Health and Care Excellence have published guidelines for nodule management, but adherence varies. Some hospitals use more conservative protocols that require more frequent follow-up, while others use less intensive schedules. Standardisation could reduce unnecessary scans and ensure that resources are focused on patients at highest risk.

Full national rollout of the lung screening programme is planned for 2027–2029, but it depends on capacity expansion. The NHS has committed to increasing CT capacity and training more radiologists, but progress has been slow. Meanwhile, the pilots continue to generate data that will inform the final design of the programme. The challenge is to ensure that the benefits of early detection are not undermined by delays in follow-up. Whether the system can adapt quickly enough to meet this challenge remains an open question, one that will determine whether lung screening fulfills its potential as a transformative public health intervention.

This article is for informational purposes only and does not constitute medical advice. All patient quotes are anonymized and used with permission from Cancer Research UK.