Lung cancer in the UK and the NHS

1. 1
   Before any symptoms: the lung health checkAged 55 to 74, registered with an English GP and have ever smoked: a risk assessment, then a low-dose CT scan if either risk model puts you over its threshold, then a scan every two yearsTarget Scan within 56 days of the lung health check; outcome letters within 28 days; national coverage of England by 2030

   The UK National Screening Committee recommended targeted screening in June 2022 for people aged 55 to 74 at high risk, with integrated smoking cessation, and the government approved the recommendation on 26 June 2023. The operating document is NHS England's standard protocol, version 3 of 3 February 2025. Eligibility is age 55 to 74 years and 364 days, registered with a GP practice in England, and having ever smoked, with no baseline scan more than three months after a 75th birthday; because GP smoking records are poor, the protocol says that once the programme is fully rolled out everyone in the age band should be given the opportunity irrespective of their recorded smoking history. GP records are re-queried at least every two years. Who gets a scan is decided by risk models, not by age and pack-years alone. The programme uses PLCOm2012, adapted for UK ethnic groups, at a six-year risk of 1.51 percent or more, and the Liverpool Lung Project model version 2 at a five-year risk of 2.5 percent or more; satisfying either is enough. The Yorkshire Lung Screening Trial is why: at those thresholds PLCOm2012 identified 91.1 percent of the cancers against 62.8 percent for the 2013 United States categorical rule. People are excluded if they are beyond the scanner's weight or size limits, cannot lie flat, are too unwell for treatment with curative intent, are on a palliative care register or are severely frail. The scan is usually in a mobile unit in a car park, should happen within 56 days of the lung health check, and the result letter should arrive within 28 days. A clear scan means a return in 24 months from the last stable or negative scan; an indeterminate nodule means surveillance at three and twelve months first, so a person can be 36 months from their baseline before their next routine round. Nodules are managed on the British Thoracic Society ladder with volumetry preferred, characterised at 5 mm or 80 cubic millimetres, and referred at 300 cubic millimetres or 8 mm with a Brock risk of 10 percent or more. The programme is expected to cost 270 million pounds a year once fully implemented; its modelling assumes 63 percent uptake and that 43.3 percent of completed risk assessments lead to a scan.

   Sources: UK National Screening Committee: lung cancer recommendation (June 2022 review): targeted screening with low-dose computed tomography is recommended for people aged 55 to 74 at high risk, with integrated smoking cessation, and the Targeted Lung Health Checks programme is a feasible starting point in England (2022-06); NHS England: targeted screening for lung cancer with low radiation dose computed tomography, the standard protocol prepared for the Lung Cancer Screening Programme, publication reference PR1646, version 3 of 3 February 2025 (eligibility, the two risk models and their thresholds, the invitation route, the exclusions, the scan interval and the nodule ladder). The publication page itself answers HTTP 202 with an empty body (2025-02-03); NHS England: quality assurance standards prepared for the Lung Cancer Screening Programme, publication reference PR1647, version 3 of 3 February 2025 (the scan within 56 days of the lung health check, and outcome letters within 28 days) (2025-02-03); Department of Health and Social Care: equality impact assessment for screening for lung cancer (published 24 July 2025), which records that the government approved the UK National Screening Committee's recommendation on 26 June 2023 and that people with no nodules are reinvited every two years (2025-07-24); NHS: lung cancer screening (the lung health check: who is invited, the telephone or online risk assessment, the scan in a mobile unit, the result letter within four weeks, and the cancer alliance areas where checks are live; page last reviewed 27 March 2023) (2023-03-27); GOV.UK: new lung cancer screening roll out to detect cancer sooner (Department of Health and Social Care, 26 June 2023): ages 55 to 74 with a GP record of smoking, 270 million pounds a year once fully implemented, up to 9,000 cancers a year and almost a million scans, 76 percent of cancers found at an earlier stage in the first phase, around 70 percent of screening delivered in mobile units in areas where people are four times more likely to smoke (2023-06-26); GOV.UK: the National Cancer Plan for England (published 4 February 2026, last updated 15 September 2026): the lung screening roll-out to 2030, the stage shift it has already produced, the narrowing of the early-diagnosis deprivation gap, the 2029 waiting-time targets and the opt-out tobacco dependence offer (2026-02-04); Department of Health and Social Care: National Cancer Plan technical annex (published 4 February 2026), which gives the programme's operating assumptions: a 63 percent uptake rate, 43.3 percent conversion from risk assessment to scan, a 0.9 percent cancer rate at the first scan and 0.6 percent at later rounds, and a 76 percent early diagnosis rate against 29 percent before the programme (2026-02-04); Gabe R and others, comparing eligibility criteria in the Yorkshire Lung Screening Trial, Journal of Thoracic Oncology 2025 (the PLCOm2012 risk model at 1.51 percent found 91.1 percent of cancers against 62.8 percent for the 2013 US Preventive Services Task Force rule) (2025)

2. 2
   Day 0: the chest X-ray decides the referralUrgent direct-access chest X-ray within two weeks under NG12; suspected cancer pathway referral on a suspicious film or on unexplained haemoptysis at 40 or over; chest X-ray reported within 24 hours and CT within 72 hours under the optimal pathway

   NG12's lung rules are unchanged since 2015 and are unusually permissive: two unexplained symptoms at 40 or over, or one if you have ever smoked. The National Optimal Lung Cancer Pathway then tries to compress what follows: the X-ray reported before the patient leaves or within 24 hours, CT the same day or within 72 hours, triage by radiology or respiratory medicine by day 3. Version 4 of the pathway, published 1 January 2024, added a direct-to-CT route for people at high risk of symptomatic lung cancer, clarified the other urgent presentation routes, and added blood-based tumour diagnostics and a molecular testing pathway. The National Cancer Plan says the artificial intelligence diagnostic fund has already put chest X-ray analysis tools into almost half of trusts and will extend them to all, and that self-referral for chest X-ray will be expanded; Roy Castle hosts the standard operating procedures of the three established self-request programmes, in Leeds, Greater Manchester and Leicester.

   Sources: NICE NG12: suspected cancer, recommendations by site (lung and pleural cancers 1.1.1 to 1.1.6), published 23 June 2015, last updated 15 April 2026 (2026-04-15); NHS England: National Optimal Lung Cancer Pathway version 4.0, 1 January 2024 (the 49-day maximum to treatment, the direct-to-CT route, the genomic and molecular pathway with its 14-day turnaround, and the timed thoracic surgery and systemic therapy pathways) (2024-01-01); GOV.UK: the National Cancer Plan for England (published 4 February 2026, last updated 15 September 2026): the lung screening roll-out to 2030, the stage shift it has already produced, the narrowing of the early-diagnosis deprivation gap, the 2029 waiting-time targets and the opt-out tobacco dependence offer (2026-02-04); Roy Castle Lung Cancer Foundation: self-request chest X-ray services, a resource hub carrying the standard operating procedures of the Leeds, Greater Manchester and Leicester programmes (2026-09-25); NICE HTG696: artificial-intelligence-derived software to analyse chest X-rays for suspected lung cancer in primary care referrals, early value assessment (28 September 2023, last updated 10 February 2025) (2025-02-10)

3. 3
   28 days: diagnosis or all-clearFaster Diagnosis Standard: told you have cancer, or that you do not, within 28 days of the referralTarget 75%, with 80% in the 2025/26 planning guidance and by March 2029

   England measures the time from an urgent suspected cancer referral, an urgent screening referral or a consultant upgrade to the day the patient is told. In July 2026 the NHS achieved 79.3 percent across all cancers; for suspected lung cancer it was 77.8 percent, made up of 82.2 percent on the urgent suspected cancer route and only 58.9 percent on the national screening programme route. The National Cancer Plan commits to 80 percent by March 2029. For lung cancer the constraint is diagnostic capacity: GIRFT's lung cancer report asked for a three working day turnaround from abnormal chest X-ray to CT report, key diagnostic investigations within 21 calendar days, PET-CT reported within five calendar days, image-guided biopsy within five working days and endobronchial ultrasound within five calendar days, and found that in the 2019 organisational audit only 46 percent of services met the three-day target. NHS England's cancer waiting times web pages answer HTTP 202 with an empty challenge to automated readers; the figures here were read from the statistical release and the monthly data file, which do resolve.

   Sources: GOV.UK: waiting times for suspected and diagnosed cancer patients, July 2026 (the definitions of the 28, 31 and 62 day standards; published 10 September 2026) (2026-09-10); NHS England: cancer waiting times statistical release for July 2026, provider based, provisional (released 10 September 2026): 79.3 percent on the 28-day standard, 92.5 percent on the 31-day and 71.2 percent on the 62-day (2026-09-10); NHS England: cancer waiting times monthly combined data, April to July 2026, provisional (the lung rows for July 2026: 77.8 percent on the 28-day standard and 60.9 percent on the 62-day, and 35.9 percent at 62 days for referrals from the screening programme) (2026-09-10); GOV.UK: the National Cancer Plan for England (published 4 February 2026, last updated 15 September 2026): the lung screening roll-out to 2030, the stage shift it has already produced, the narrowing of the early-diagnosis deprivation gap, the 2029 waiting-time targets and the opt-out tobacco dependence offer (2026-02-04); GIRFT: lung cancer, national specialty report (Paul Beckett, Sarah Doffman and Elizabeth Toy, October 2021): 33 recommendations, including an 85 percent radical treatment rate in stage I to II, a surgical resection rate above 20 percent and a ten calendar day turnaround for molecular profiling (2021-10); NHS England: cancer waiting times statistics (the page answered HTTP 202 with an empty AWS web application firewall challenge to OnCo on 25 September 2026)

4. 4
   Staging and the lung multidisciplinary teamContrast-enhanced CT of chest, liver, adrenals and lower neck before biopsy; PET-CT for everyone who could have treatment with curative intent; every case discussed by a lung cancer multidisciplinary team

   NICE NG122 recommendation 1.2.2 asks for contrast-enhanced CT including the liver, adrenals and lower neck, and 1.2.14 says do it before any biopsy. Recommendation 1.2.4 says ensure everyone who could potentially have treatment with curative intent is offered PET-CT before treatment, and 1.2.5 asks every cancer alliance to have a system of rapid access to it. Recommendation 1.2.8 offers endobronchial ultrasound-guided transbronchial needle aspiration for paratracheal and peribronchial lesions, and 1.2.9 asks every cancer alliance to have at least one centre with endobronchial or endoscopic ultrasound. Recommendations 1.2.31 to 1.2.33 require every suspected case to be referred to a member of a lung cancer multidisciplinary team, every working diagnosis to be discussed at that team's meeting, and fast-track lung cancer clinics to exist. The optimal pathway asks that a surgeon be present at more than 95 percent of meetings and that the full team meeting happen by day 21. NHS England's timed lung cancer diagnostic pathway names the core membership, which NG122 itself does not: lead clinician, radiologist, pathologist, oncologist, clinical nurse specialist and a relevant allied health professional, working with a pathway navigator, with a named clinical lead for every team. Its day-by-day audit tool runs from the chest X-ray at day minus three to triage at day 3, the fast-track clinic at day 6, a test bundle including at least PET-CT and spirometry at day 14, the multidisciplinary team meeting at day 21 and follow-up at day 28. Staging in NG122 still uses the seventh edition of the American Joint Committee on Cancer system; brain imaging is not offered in clinical stage 1 disease without neurological symptoms, is CT in stage 2 and MRI in stage 3.

   Sources: NICE NG122: diagnosis and staging (the CT, PET-CT, EBUS-TBNA and sampling recommendations 1.2.1 to 1.2.34, including the multidisciplinary team and the lung cancer clinical nurse specialist) (2026-02); NHS England: National Optimal Lung Cancer Pathway version 4.0, 1 January 2024 (the 49-day maximum to treatment, the direct-to-CT route, the genomic and molecular pathway with its 14-day turnaround, and the timed thoracic surgery and systemic therapy pathways) (2024-01-01); NHS England: implementing a timed lung cancer diagnostic pathway, publication reference PRN1346 (12 October 2023, last modified 25 June 2024), by Peter Johnson and David Baldwin: the day-by-day audit tool and the core membership of the lung cancer multidisciplinary team (2024-06-25); GIRFT: lung cancer, national specialty report (Paul Beckett, Sarah Doffman and Elizabeth Toy, October 2021): 33 recommendations, including an 85 percent radical treatment rate in stage I to II, a surgical resection rate above 20 percent and a ten calendar day turnaround for molecular profiling (2021-10)

5. 5
   Reflex molecular testing, and what happens when the sample is too smallComprehensive next-generation sequencing through a Genomic Laboratory Hub, requested reflexly by the pathologist; a full molecular report within 14 calendar days of the sample being taken

   NG122 recommendation 1.2.11 says samples must be adequate to allow tumour subtyping and the assessment of molecular markers, and 1.2.12, amended in February 2026, now points directly at the National Genomic Test Directory for the next-generation sequencing panels, having previously described single-mutation testing. The National Optimal Lung Cancer Pathway sets the clock: tissue acquired on day 0, morphology and slide preparation for reflex testing by day 3, PD-L1 immunohistochemistry and slide preparation locally, then reflex sequencing, with a full molecular report no more than 14 calendar days after the sample was taken and the treating specialist seeing the patient within three working days of the result. Both DNA and RNA sequencing should be done in any histological subtype of non-small-cell disease. If there is not enough tissue, the pathologist emails or telephones the lung multidisciplinary team the same day, and the team decides between repeat sampling (allowed to day 21) and a salvage route: a limited DNA panel, fluorescence in situ hybridisation for ALK and ROS1, and a blood predictive biomarker. Circulating tumour DNA testing for non-small-cell lung cancer was added to the National Genomic Test Directory in May 2025 after an NHS pilot in which results came back on average 16 days faster than tissue genotyping. GIRFT asked for a maximum ten calendar day turnaround, and Roy Castle campaigns for 14 days as a patient right.

   Sources: NICE NG122: diagnosis and staging (the CT, PET-CT, EBUS-TBNA and sampling recommendations 1.2.1 to 1.2.34, including the multidisciplinary team and the lung cancer clinical nurse specialist) (2026-02); NICE NG122: update information (February 2026 amended recommendation 1.2.12 from single-mutation testing to comprehensive next-generation sequencing panels through genomic laboratory hubs, and added links to the technology appraisals; March 2024 removed the mobocertinib pathways after that guidance was withdrawn) (2026-02); NHS England: National Optimal Lung Cancer Pathway version 4.0, 1 January 2024 (the 49-day maximum to treatment, the direct-to-CT route, the genomic and molecular pathway with its 14-day turnaround, and the timed thoracic surgery and systemic therapy pathways) (2024-01-01); GOV.UK: the National Cancer Plan for England (published 4 February 2026, last updated 15 September 2026): the lung screening roll-out to 2030, the stage shift it has already produced, the narrowing of the early-diagnosis deprivation gap, the 2029 waiting-time targets and the opt-out tobacco dependence offer (2026-02-04); GIRFT: lung cancer, national specialty report (Paul Beckett, Sarah Doffman and Elizabeth Toy, October 2021): 33 recommendations, including an 85 percent radical treatment rate in stage I to II, a surgical resection rate above 20 percent and a ten calendar day turnaround for molecular profiling (2021-10); Roy Castle Lung Cancer Foundation: campaigns (Let Go of the Labels, This is Lung Cancer, and the policy ask that no one should wait longer than 14 days for genomic testing) (2026-09-25)

6. 6
   The lung cancer clinical nurse specialistA lung cancer clinical nurse specialist available at all stages of care, and contact around the time of diagnosisTarget More than 90% (National Lung Cancer Audit)

   NG122 recommendation 1.1.1 says a lung cancer clinical nurse specialist should be available at all stages of care, and 1.2.34 says every cancer unit or centre should have one or more, seeing people before, at and after diagnosis. The audit's problem is not the number but the record: among English patients who had the field filled in, 93.1 percent had contact with a nurse specialist, comfortably above the 90 percent target, but the field was complete for only 64.2 percent of records and no English trust met the completeness target. Only 56 trusts exceeded 70 percent completeness. Wales records it for 97.5 percent of patients and reports 94.9 percent contact. The audit launched a quality improvement initiative on this indicator in autumn 2025.

   Sources: NICE NG122 recommendation 1.1.1: a lung cancer clinical nurse specialist should be available at all stages of care (2026-02); NICE NG122: diagnosis and staging (the CT, PET-CT, EBUS-TBNA and sampling recommendations 1.2.1 to 1.2.34, including the multidisciplinary team and the lung cancer clinical nurse specialist) (2026-02); National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival) (2026-02)

7. 7
   Stopping smoking, as part of the treatmentAdvise stopping as soon as lung cancer is suspected; an opt-out tobacco dependence service in hospital; do not postpone surgery to allow someone to stop

   NG122 recommendations 1.3.1 to 1.3.3 are short and specific: tell people that smoking increases the risk of pulmonary complications after lung cancer surgery, advise them to stop as soon as the diagnosis is suspected and say why, and do not postpone surgery to allow them to stop. The National Cancer Plan commits hospitals to integrating opt-out cessation support into all routine care and to including smoking status in clinical assessments for non-urgent operations, with 70 million pounds more for local authority stop smoking services. Inside screening the evidence is British and good: in the Yorkshire Lung Screening Trial 89 percent of eligible smokers accepted an immediate consultation with a cessation practitioner at the same appointment, 75 percent took ongoing support and 12.4 percent were carbon-monoxide-validated quitters at four weeks. The UK National Screening Committee's recommendation was explicitly for screening with integrated smoking cessation, not screening alone. Outside screening, NICE NG209 section 1.14 asks secondary care to offer behavioural support during the current outpatient visit or inpatient stay, to provide it immediately at the outpatient site including at preoperative assessment, and to send people home with at least a week of stop-smoking medicine. The NHS Long Term Plan commitment that NHS England publishes covers inpatients, maternity and mental health settings rather than outpatient clinics.

   Sources: NICE NG122: management (stop-smoking 1.3.1 to 1.3.3, fitness assessment 1.4, surgery and radiotherapy 1.5, multimodality treatment 1.6 with the perioperative appraisals, small-cell 1.8 to 1.12) (2026-02); GOV.UK: the National Cancer Plan for England (published 4 February 2026, last updated 15 September 2026): the lung screening roll-out to 2030, the stage shift it has already produced, the narrowing of the early-diagnosis deprivation gap, the 2029 waiting-time targets and the opt-out tobacco dependence offer (2026-02-04); Murray RL and others, a co-located stop-smoking service inside lung screening, European Respiratory Journal 2024 (89 percent of eligible smokers accepted an immediate consultation; 12.4 percent were carbon-monoxide-validated quitters at four weeks) (2024); UK National Screening Committee: lung cancer recommendation (June 2022 review): targeted screening with low-dose computed tomography is recommended for people aged 55 to 74 at high risk, with integrated smoking cessation, and the Targeted Lung Health Checks programme is a feasible starting point in England (2022-06); NICE NG209: tobacco, preventing uptake, promoting quitting and treating dependence (published 30 November 2021, last updated 4 February 2025), section 1.14 on secondary care, which asks for immediate behavioural support at the outpatient site and a week's pharmacotherapy on discharge (2025-02-04); NHS England: tobacco dependency programme (last modified 23 December 2024), which records the NHS Long Term Plan commitment to tobacco dependency treatment for all overnight inpatients by the end of 2023/24 (2024-12-23)

8. 8
   31 days: decision to first treatmentTreatment starts within 31 days of the decision to treatTarget 96% (England by March 2029); 95% (Scotland); 98% (Northern Ireland)

   Scotland is the only nation that publishes a lung-specific split, and lung does well on this measure: 1,033 of 1,050 eligible referrals, or 98.4 percent, started treatment within 31 days in the quarter ending 31 March 2026, with a median wait of two days, against an all-cancer figure of 94.5 percent. The audit's equivalent internal measure is harsher: the median time from the decision to treat to the start of systemic anti-cancer therapy was 16 days in England, and in small-cell lung cancer, where the tumour doubles fastest, the audit's own standard is that at least 80 percent should start within 14 days of pathological diagnosis and only 44 percent did. England achieved 92.5 percent across all cancers in July 2026 and 94.3 percent for lung. Northern Ireland, whose target is 98 percent, treated 110 of 125 lung patients within 31 days in January 2026, 89 of 94 in February and 114 of 127 in March, with a median wait of eight to eleven days.

   Sources: GOV.UK: waiting times for suspected and diagnosed cancer patients, July 2026 (the definitions of the 28, 31 and 62 day standards; published 10 September 2026) (2026-09-10); NHS England: cancer waiting times statistical release for July 2026, provider based, provisional (released 10 September 2026): 79.3 percent on the 28-day standard, 92.5 percent on the 31-day and 71.2 percent on the 62-day (2026-09-10); NHS England: cancer waiting times monthly combined data, April to July 2026, provisional (the lung rows for July 2026: 77.8 percent on the 28-day standard and 60.9 percent on the 62-day, and 35.9 percent at 62 days for referrals from the screening programme) (2026-09-10); Public Health Scotland: cancer waiting times, table 1, compliance with standard (quarter ending 31 March 2026): lung 83.6 percent at 62 days and 98.4 percent at 31 days (2026-06-30); Northern Ireland Department of Health: cancer waiting times, January to March 2026 (published 2 July 2026, last updated 11 September 2026), whose tumour-site tables give the lung 31-day performance (2026-09-11); National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival) (2026-02)

9. 9
   62 days: referral to first treatment, against a 49-day optimal pathwayFirst treatment within 62 days of the urgent referral; the National Optimal Lung Cancer Pathway asks for 49 daysTarget 85% (England by March 2029); 95% (Scotland); 75% (Wales); 95% (Northern Ireland)

   This is where lung cancer care in England fails most clearly, and the audit measures it against the tighter clinical standard rather than the national one. Of people with stage 1 or 2 non-small-cell lung cancer having surgery in England in 2024, the median time from referral to operation was 81 days and only 12 percent were treated within 49 days; for radical radiotherapy the median was 98 days and 3.2 percent met the target; for systemic therapy in stage 3B to 4 disease the median was 63 days and 27 percent met it. The audit's commentary says the growth in demand for surgery is lengthening the wait and that this will continue as screening expands, and it names thoracic surgery capacity as a priority. The national figures say the same thing: in July 2026, 71.2 percent of people across all cancers started treatment within 62 days, but only 60.9 percent of people with lung cancer, and only 35.9 percent of those referred through the screening programme. Lung cancer is about ten points worse than the average, and the screening route, which exists to catch cancer early, is the slowest door in the building. Scotland is the mirror image: it reported 83.6 percent of lung referrals treated within 62 days in the quarter to March 2026, well above its all-cancer figure of 72.2 percent though below its 95 percent standard, ranging from 67.7 percent in Greater Glasgow and Clyde to 94.1 percent in Lanarkshire. Wales publishes only an all-cancer figure, 60.1 percent in July 2026 against a 75 percent target. Northern Ireland republished its 62-day figures on 11 September 2026 after an error in the encompass patient administration system inflated them: the corrected all-cancer performance for the quarter to March 2026 is 29.6 percent.

   Sources: NHS England: National Optimal Lung Cancer Pathway version 4.0, 1 January 2024 (the 49-day maximum to treatment, the direct-to-CT route, the genomic and molecular pathway with its 14-day turnaround, and the timed thoracic surgery and systemic therapy pathways) (2024-01-01); National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival) (2026-02); NHS England: cancer waiting times monthly combined data, April to July 2026, provisional (the lung rows for July 2026: 77.8 percent on the 28-day standard and 60.9 percent on the 62-day, and 35.9 percent at 62 days for referrals from the screening programme) (2026-09-10); Public Health Scotland: cancer waiting times, table 1, compliance with standard (quarter ending 31 March 2026): lung 83.6 percent at 62 days and 98.4 percent at 31 days (2026-06-30); Welsh Government: NHS activity and performance summary, July and August 2026 (published 17 September 2026): 60.1 percent of suspected cancer pathways started treatment within 62 days against a 75 percent target; no lung-specific figure is published (2026-09-17); Northern Ireland Department of Health: revised cancer waiting times against the 62-day target (published 11 September 2026), after an error in the encompass patient administration system's suspension logic inflated performance: 29.6 percent in the quarter to 31 March 2026 (2026-09-11); GOV.UK: the National Cancer Plan for England (published 4 February 2026, last updated 15 September 2026): the lung screening roll-out to 2030, the stage shift it has already produced, the narrowing of the early-diagnosis deprivation gap, the 2029 waiting-time targets and the opt-out tobacco dependence offer (2026-02-04)

10. 10
    SurgeryLobectomy, open or thoracoscopic, for everyone well enough for treatment with curative intent; sublobar resection or stereotactic ablative radiotherapy if lobectomy is declined or contraindicatedTarget Surgical resection in at least 17% of people with non-small-cell lung cancer (audit); more than 20% (GIRFT)

    NG122 recommendation 1.5.1 offers lobectomy, open or thoracoscopic, and 1.5.2 reserves more extensive surgery for clear margins; 1.5.3 requires hilar and mediastinal lymph node sampling or en bloc resection in every curative operation. Recommendation 1.5.5 offers stereotactic ablative radiotherapy or sublobar resection to people with stage 1 to 2A disease who decline lobectomy or in whom it is contraindicated. VIOLET, the UK trial, showed keyhole surgery leaves people with better physical function at five weeks and fewer serious adverse events after discharge, with the same survival at a year. In England in 2024, 7,878 people had surgery, 21.8 percent of everyone with non-small-cell disease, up from 6,547 and 19.6 percent in 2023; resection rates ranged from 15 to 37 percent between cancer alliances. Ninety-day survival after resection was 98.4 percent across England and Wales, on 8,559 operations in 28 thoracic units. Fitness still decides: among people with stage 1 or 2 disease, 75.3 percent with performance status 0 had surgery, 52.2 percent with performance status 1 and 19.2 percent with performance status 2.

    Sources: NICE NG122: management (stop-smoking 1.3.1 to 1.3.3, fitness assessment 1.4, surgery and radiotherapy 1.5, multimodality treatment 1.6 with the perioperative appraisals, small-cell 1.8 to 1.12) (2026-02); National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival) (2026-02); National Lung Cancer Audit: State of the Nation 2026, data tables (the 90-day postoperative survival sheet names every NHS thoracic unit in England and Wales with its 2024 resection count) (2026-02); Lim E and others, VIOLET: video-assisted thoracoscopic or open lobectomy in early-stage lung cancer, NEJM Evidence 2022 (503 randomised; better physical function at five weeks and fewer serious adverse events after discharge with keyhole surgery, same survival at a year) (2022); GIRFT: lung cancer, national specialty report (Paul Beckett, Sarah Doffman and Elizabeth Toy, October 2021): 33 recommendations, including an 85 percent radical treatment rate in stage I to II, a surgical resection rate above 20 percent and a ten calendar day turnaround for molecular profiling (2021-10)

11. 11
    Radiotherapy with curative intentStereotactic ablative radiotherapy for stage 1 to 2A disease when surgery is declined or contraindicated; 55 Gy in 20 fractions or 60 to 66 Gy in 30 to 33 fractions when conventional radical radiotherapy is used

    NG122 recommendation 1.5.8 offers stereotactic ablative radiotherapy to people with stage 1 to 2A disease who decline surgery or in whom it is contraindicated, and conventional or hyperfractionated radiotherapy if that too is contraindicated; 1.5.11 says follow the SABR Consortium guidance on fractionation; 1.5.12 sets the conventional doses. Recommendation 1.5.7 asks that everyone treated with curative intent be included in a national quality assurance programme. Britain's contribution here is CHART, invented at Mount Vernon, which gave the whole dose in twelve consecutive days and cut the relative risk of death by about a quarter; the schedule proved hard to run and modern practice uses the doses above, but the biological argument it settled, that tumour repopulation during a long course costs lives, is still the reason radiotherapy courses are kept short. In England in 2024 the median wait from referral to radical radiotherapy in stage 1 to 2 disease was 98 days, the longest interval the audit measures.

    Sources: NICE NG122: management (stop-smoking 1.3.1 to 1.3.3, fitness assessment 1.4, surgery and radiotherapy 1.5, multimodality treatment 1.6 with the perioperative appraisals, small-cell 1.8 to 1.12) (2026-02); Saunders M and others, continuous hyperfractionated accelerated radiotherapy against conventional radiotherapy in non-small-cell lung cancer, Lancet 1997 (563 patients, 24 percent reduction in the relative risk of death, two-year survival 20 to 29 percent) (1997); National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival) (2026-02)

12. 12
    Stage 3 disease and the perioperative drugsAssessment by both a thoracic oncologist and a thoracic surgeon for anyone potentially suitable for multimodality treatment; chemoradiotherapy with surgery considered in operable stage 3A N2

    NG122 recommendation 1.6.1 requires assessment by both a thoracic oncologist and a thoracic surgeon; 1.6.3 to 1.6.5 offer chemoradiotherapy with surgery for operable stage 3A N2 disease, with the operation scheduled three to five weeks after the chemoradiotherapy finishes; 1.6.7 says centres performing lung resections should validate their data for the National Lung Cancer Audit. The guideline now also carries the perioperative appraisals directly: neoadjuvant nivolumab with chemotherapy (TA876), perioperative durvalumab (TA1030), perioperative pembrolizumab (TA1017) and perioperative nivolumab (TA1127), plus adjuvant osimertinib (TA1043), alectinib (TA1014), atezolizumab (TA1071) and pembrolizumab (TA1037). For unresectable stage 3 disease, durvalumab after concurrent chemoradiotherapy (TA798) and, for EGFR-mutant disease, osimertinib after chemoradiotherapy (TA1156). The audit's first recommendation for 2026 is about this step: only 59.1 percent of English patients with stage 3A disease and performance status 0 to 2 were given treatment with curative intent, and it asks cancer alliances to audit their multidisciplinary team decisions to find out why.

    Sources: NICE NG122: management (stop-smoking 1.3.1 to 1.3.3, fitness assessment 1.4, surgery and radiotherapy 1.5, multimodality treatment 1.6 with the perioperative appraisals, small-cell 1.8 to 1.12) (2026-02); National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival) (2026-02); NICE TA1127: nivolumab with chemotherapy before surgery then alone after surgery for resectable non-small-cell lung cancer (4 February 2026; recommendation 1.2 says use the least expensive of nivolumab, pembrolizumab and durvalumab) (2026-02-04); NICE TA798: durvalumab for maintenance treatment of unresectable non-small-cell lung cancer after platinum-based chemoradiation (22 June 2022, PD-L1 of 1 percent or more and only after concurrent chemoradiotherapy; the PACIFIC indication) (2022-06-22)

13. 13
    Systemic anti-cancer therapy in advanced diseaseMolecular and PD-L1 results before treatment; platinum-based chemotherapy with or without immunotherapy, or a targeted drug where a driver is foundTarget More than 70% of fit people with stage 3B to 4 non-small-cell disease and more than 70% of people with small-cell disease to receive systemic therapy (audit)

    The funding table below sets out what is available by biomarker. The audit's finding is that access, not availability, is the constraint: 63.4 percent of English patients with stage 3B to 4 non-small-cell disease and performance status 0 to 1 received systemic therapy in 2024, essentially unchanged since 2022, against a 70 percent standard that only 42 of 123 trusts met, with cancer alliance rates ranging from 42 to 84 percent. In small-cell disease 71.2 percent received systemic therapy, just over the standard but down from 73.8 percent in 2023. The audit concludes that the growing demand for systemic treatment is outpacing service provision and asks for a review of capacity, naming molecular pathology capacity specifically.

    Sources: National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival) (2026-02); NICE NG122: management (stop-smoking 1.3.1 to 1.3.3, fitness assessment 1.4, surgery and radiotherapy 1.5, multimodality treatment 1.6 with the perioperative appraisals, small-cell 1.8 to 1.12) (2026-02); NHS England: national Cancer Drugs Fund list version 1.408, updated 24 September 2026, read in full (320 pages): four lung indications in the Cancer Drugs Fund section and 43 routinely funded lung indications in section B, each with its Blueteq form, appraisal reference and funding date (2026-09-24)

14. 14
    Small-cell lung cancer, which runs on a shorter clockAssessment by a thoracic oncologist within one week of the decision to recommend treatment; four to six cycles of platinum-based chemotherapy; twice-daily radiotherapy with concurrent chemotherapy in limited-stage disease; prophylactic cranial irradiation

    Small-cell disease was 6.6 percent of English lung cancers in 2024, down from 8.6 percent in 2019, and 9.1 percent in Wales. NG122 recommendation 1.8.1 asks for assessment by a thoracic oncologist within one week of the decision to recommend treatment. In limited-stage disease, 1.10.1 offers four to six cycles of cisplatin-based chemotherapy, 1.10.2 offers twice-daily radiotherapy concurrent with it starting in cycle one or two, 1.10.5 offers prophylactic cranial irradiation at 25 Gy in ten fractions, and 1.10.6 now carries durvalumab after chemoradiotherapy (TA1099). In extensive-stage disease, 1.11.1 to 1.11.3 offer platinum chemotherapy with durvalumab (TA1041) or atezolizumab (TA638), and 1.11.4 and 1.11.5 consider thoracic radiotherapy and prophylactic cranial irradiation after a response. The twice-daily schedule survives because of CONVERT, a Manchester-led trial funded by Cancer Research UK across 73 centres in eight countries, which was designed to show the once-daily schedule was better and did not. In relapse, oral topotecan is the only recommended drug (TA184) and tarlatamab was refused (TA1091). The audit's fourth recommendation is about speed: the median time from diagnosis to treatment was 16 days against a 14-day standard, and only 44 percent were treated in time.

    Sources: NICE NG122: management (stop-smoking 1.3.1 to 1.3.3, fitness assessment 1.4, surgery and radiotherapy 1.5, multimodality treatment 1.6 with the perioperative appraisals, small-cell 1.8 to 1.12) (2026-02); National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival) (2026-02); Faivre-Finn C and others, CONVERT, Lancet Oncology 2017 (547 patients; median survival 30 months twice-daily against 25 months once-daily, hazard ratio 1.18, so twice-daily 45 Gy remained the standard) (2017); NICE TA1099: durvalumab for limited-stage small-cell lung cancer after platinum-based chemoradiotherapy (1 October 2025, the ADRIATIC indication) (2025-10-01); NICE TA1091: tarlatamab for extensive-stage small-cell lung cancer after two or more treatments, not recommended (20 August 2025) (2025-08-20)

15. 15
    Prehabilitation and exerciseRegular aerobic and resistance exercise during treatment with curative intent, including before surgery

    The audit's fifth recommendation for 2026 asks that everyone diagnosed with stage 1 to 3 disease be recommended regular aerobic and resistance exercise during treatment with curative intent, including preoperative exercise before lung cancer surgery, citing the American Society of Clinical Oncology's 2022 guideline. It made this recommendation because the proportion of people with stage 1 to 2 disease having surgery falls so steeply with fitness. The National Optimal Lung Cancer Pathway asks teams to optimise comorbidities, smoking and nutrition as early as possible and to refer to local prehabilitation services, and the National Cancer Plan promises a digital-first prehabilitation offer through the NHS App. Fit 4 Surgery 2, a 902-patient NIHR trial run from Birmingham across 20 thoracic units, is testing whether an app-based programme actually reduces complications.

    Sources: National Lung Cancer Audit: State of the Nation 2026, full report (39,409 people in England and 2,135 in Wales diagnosed in 2024; stage, emergency presentation, curative intent, surgery, systemic therapy, times to treatment and survival) (2026-02); NHS England: National Optimal Lung Cancer Pathway version 4.0, 1 January 2024 (the 49-day maximum to treatment, the direct-to-CT route, the genomic and molecular pathway with its 14-day turnaround, and the timed thoracic surgery and systemic therapy pathways) (2024-01-01); GOV.UK: the National Cancer Plan for England (published 4 February 2026, last updated 15 September 2026): the lung screening roll-out to 2030, the stage shift it has already produced, the narrowing of the early-diagnosis deprivation gap, the 2029 waiting-time targets and the opt-out tobacco dependence offer (2026-02-04); ISRCTN40412033: Fit 4 Surgery 2, an app-based prehabilitation programme before and after lung cancer surgery (University of Birmingham, NIHR; target 902, 20 thoracic units) (2026-09-25)

The NHS position of every approved product is on the NHS coverage page; the same decisions by country are on HTA decisions.

Match a report to targets and drugs on the biomarker matrix.

Roy Castle Lung Cancer Foundation

Charity

• Ask the Nurse: a free confidential helpline on 0800 358 7200, answered by experienced lung cancer nurses, Monday to Thursday 9am to 5pm and Friday 9am to 4pm
• Keep in Touch: fortnightly one-to-one calls for up to twelve sessions, for patients or carers
• Free information days across the UK with oncologists, thoracic surgeons, nurses, physiotherapists and dietitians, and nurse-led local support groups
• Information on symptoms, screening, diagnosis, treatment, living with lung cancer, advanced disease and recurrence
• Travel insurance and will-writing guidance, and a stop-smoking section
• Campaigning on stigma (Let Go of the Labels) and on a 14-day limit for genomic testing

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Cancer Research UK

Charity

• Freephone nurse helpline on 0808 800 40 40, Monday to Friday 9 to 5
• Plain-English information on lung cancer, reviewed by lung cancer clinical nurse specialists, and a clinical trial database
• The UK statistics quoted on this page
• Funder of CONVERT, ADSCaN, HALT, LungVax, Lung-SEARCH, PROMINENT, the National Lung Matrix Trial and CONCORDE

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Macmillan Cancer Support

Charity

• Support line on 0808 808 00 00, 8am to 8pm every day, with online chat and an email service
• Separate information for non-small-cell, small-cell and secondary lung cancer, reviewed by a consultant clinical oncologist and carrying the PIF TICK quality mark
• Understanding lung cancer booklet and audiobook, and an easy-read version
• An online community lung cancer forum, and cancercaremap.org to find local services
• Grants and benefits advice

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Maggie's

Charity

• 29 centres across the UK beside major cancer hospitals, plus online support; support line 0300 123 1801
• Courses such as Getting Started With Cancer Treatment, support groups and workshops in centres and online
• One-to-one support with a psychologist, a benefits adviser or a cancer support specialist, free and without an appointment

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NHS lung cancer information and the lung cancer screening programme

NHS

• Symptoms, tests and treatment on nhs.uk, reviewed 20 August 2026
• The lung cancer screening page: who is invited, what happens at a lung health check, and the cancer alliance areas where checks are live
• Stop-smoking advice offered to current smokers at the screening appointment

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Free NHS prescriptions in England (medical exemption certificate)

Cost and benefit

• Prescriptions cost 9.90 pounds an item in England unless you are exempt
• Anyone being treated for cancer, the effects of cancer or the effects of cancer treatment is entitled to a five-year medical exemption certificate; ask the hospital or GP for the FP92A form

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Prescriptions in Scotland, Wales and Northern Ireland

Cost and benefit

• Scotland: free for everyone, with no certificate needed
• Wales: free for anyone registered with a Welsh GP
• Northern Ireland: all prescriptions dispensed there are free

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Special rules for end of life (SR1)

Cost and benefit

• If a doctor, consultant or specialist nurse says you may have 12 months or less to live, claims for Personal Independence Payment, Universal Credit, Employment and Support Allowance and Attendance Allowance are fast-tracked at the higher rate with no assessment
• This matters more in lung cancer than in most: median survival in stage 4 disease was 95 days in England in 2024

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Personal Independence Payment and Attendance Allowance

Cost and benefit

• Non-means-tested payments for people whose illness or treatment affects daily living or mobility: Personal Independence Payment under State Pension age, Attendance Allowance over it
• Breathlessness, fatigue and the effects of thoracic surgery are the kinds of daily-living difficulty these are meant for

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Healthcare Travel Costs Scheme

Cost and benefit

• Help with fares to hospital for people on qualifying benefits or a low income
• It matters in lung cancer because radical radiotherapy can mean daily attendance for four to six and a half weeks, and because the disease is concentrated in the poorest fifth of the population

Open →

Macmillan Grants

Cost and benefit

• One-off payments for costs such as heating, travel or clothing; a nurse or social worker applies with you
• Heating matters here: breathlessness is worse in a cold house

Open →

More schemes by country on Assistance; costs of care on Costs.

• Every HTML page on england.nhs.uk answers HTTP 202 with an empty Amazon Web Services firewall challenge body to automated readers: the National Genomic Test Directory page, the Cancer Drugs Fund list page, the cancer waiting times pages, the lung screening protocol page and the thoracic surgery service specification page. The files those pages link to, under wp-content/uploads, do resolve, and so does the site's content interface, which is how the current filenames were found: every guessed filename in the older Cancer Drugs Fund version-1.NNN pattern answered 404, and the live file is version 1.408. So the content on this page is sound but no england.nhs.uk web page could be read directly, and a reader following one of those links in a script will see nothing.
• Wales publishes no lung-specific waiting-time figure. Its suspected cancer pathway data are reported for all cancers together in the monthly NHS activity and performance summary; the site-level and tumour-site data sit on StatsWales, whose catalogue pages answered HTTP 200 with navigation chrome and no data and whose comma-separated download address answered 404, and the underlying publisher, Digital Health and Care Wales, is not a public UK health domain this page cites. Northern Ireland publishes no 28-day faster diagnosis standard, and its 62-day figures are tumour-site aggregated; its lung split exists only for the 31-day standard.
• NDRS cancer registration statistics for England are unreachable. Every digital.nhs.uk address, including files.digital.nhs.uk, answered HTTP 403 with a Cloudflare challenge to a default client, to a Chrome user agent over HTTP/2 and to a Googlebot user agent. The GOV.UK landing pages for Cancer Survival in England 2016 to 2020 and Routes to Diagnosis 2018 exist but carry no attachments, only links back to the blocked host. The England survival-by-stage figures on this page therefore come from the archived 2014 to 2018 Public Health England release, whose data tables are on assets.publishing.service.gov.uk and do resolve.
• Cancer Research UK has rebuilt its statistics section and moved most breakdowns, including lung incidence by deprivation quintile, into JavaScript data hubs on a separate analytics host; the old deprivation sub-pages now answer 404. The deprivation figures quoted here are the ones CRUK still prints in the served HTML (the mortality rate ratios, the deaths linked with deprivation, and the five-year survival split), plus the four national registries' own workbooks. CRUK's Cancer in the UK 2025 deprivation report, which carries the England incidence rates of 128 against 48 per 100,000, is served from CRUK's content delivery network rather than from cancerresearchuk.org, so it is named rather than cited as a source row.
• The National Lung Cancer Audit publishes no biomarker testing rates for England. A full-text search of the 2026 State of the Nation report for EGFR, ALK, ROS1, PD-L1, molecular, genomic and biomarker returns a single hit, in a recommendation asking trusts to ensure molecular pathology capacity. The only NLCA biomarker data anywhere is a blog about Wales. There is therefore no published figure for what proportion of English lung cancer patients receive the reflex testing NG122 requires, which is the largest single evidence gap on this page.
• GIRFT began answering HTTP 403 to page requests part-way through the check: its site search, its lung cancer workstream page and its workstreams index all refused, though the reports index and the report PDFs themselves resolved. The lung cancer national specialty report quoted here is dated October 2021 and is the most recent GIRFT lung output; there is no GIRFT lung cancer best practice timed pathway, and the timed standard both GIRFT and the audit use is NHS England's National Optimal Lung Cancer Pathway, version 4.0 of 1 January 2024.
• Two of the most important British lung cancer studies have no ISRCTN record and so cannot be linked to a UK registry: TRACERx, which is NCT01888601, and SUMMIT, which is NCT03934866. Searches of the ISRCTN API for both returned zero records, as did a search for SARON. Their rows link to the NIHR Be Part of Research search instead, and their results come from the published papers. ISRCTN record pages themselves answer HTTP 200 but serve a JavaScript cookie challenge, so every trial on this page was read through the registry's public API.
• Eight UK lung cancer researchers whose role is documented on a trial record or a published paper have no public professional page that could be read, so they have no record here: Mariam Jamal-Hanjani, Sam Janes and Neal Navani (ucl.ac.uk answered 403, uclh.nhs.uk answered 403 and the UCL profiles site renders in the browser only), Michael Davidson, Robert Rintoul (four addresses tried, two 404s and two pages without the name), Yvonne Summers, Judith Cave and Anna Bibby. Charles Swanton's UCL Cancer Institute profile also answered 403; his record cites the Francis Crick Institute page instead. Matthew Callister has no reachable University of Leeds page, so the Leeds Teaching Hospitals consultant directory is cited.
• Roy Castle Lung Cancer Foundation's own contacts page is the only readable source here for the UK Lung Cancer Coalition, Asthma and Lung UK, ALK Positive UK, EGFR Positive UK and Lung Cancer Nursing UK; none of their own sites is a public UK health, government or university domain of the kind this page cites, so none is quoted directly and none has a support row.
• The research funding figure on this page, that lung cancer caused 26 percent of UK cancer deaths while receiving 6 percent of cancer research funding, comes from 2010 National Cancer Research Institute data published in 2015. No more recent UK-wide funding-against-burden comparison could be found on a public UK domain. Roy Castle's current campaign statements make the same argument but carry no percentage.
• health-ni.gov.uk serves its pages through a Varnish caching layer that answers HTTP 403 to some requests and HTTP 200 to others, apparently at random. The Northern Ireland cancer strategy, its progress report and the revised cancer waiting times release quoted here were all read, but a reader following those links in a script may get nothing. The Scottish Government's site behaved the same way under repeated requests, answering 200 and then 202 for the same address.
• Blackpool Teaching Hospitals NHS Foundation Trust performed 261 lung cancer resections in 2024 and belongs in the centres list, but its website did not respond to any request during the check, so it is named in the centres note rather than given a card. NHS Grampian's site also failed to respond, so Aberdeen Royal Infirmary, the third Scottish cardiothoracic centre, is named in the note rather than given a card, and the Golden Jubilee National Hospital, which does the most cardiothoracic work in Scotland, is on a domain this page does not cite, so it too appears only in the note.
• No NHS England document names the thoracic surgery centres. Service specification 170016/S sets the volume rules and says there were 29 units in England when it was written, but it lists none of them, and it has not been refreshed since July 2017. The centre cards here are therefore built from the National Lung Cancer Audit's 2024 resection counts, which name every English and Welsh unit, cross-checked against each trust's own service page where one exists. Three trusts with audit resection counts have no readable thoracic surgery page of their own: University Hospitals Coventry and Warwickshire describes its centre as cardiac, University Hospital Southampton's site is rendered in the browser only, and University Hospitals Bristol and Weston has no thoracic page. Cardiff and Vale University Health Board's own service directory lists no cardiothoracic or thoracic surgery service at all, although the audit records 162 resections against it, so its card names the health board rather than a hospital.
• There is no published national statistic for how long genomic testing takes. The National Genomic Test Directory has no turnaround column, and NHS England's genomic testing activity release says only activity data has been published and that waiting-time data is planned for a future publication. The 46 percent and 38 percent figures quoted on this page are from the 2019 GIRFT and audit organisational survey and the 18-day median is from the audit's 2020 spotlight on people diagnosed in 2017; nothing newer exists.
• The version of the National Optimal Lung Cancer Pathway cited here, version 4.0 of 1 January 2024, is hosted by a cancer alliance rather than by NHS England, which publishes no copy of its own that could be read. NHS England's own timed lung cancer diagnostic pathway, which does resolve through its content interface, carries the day-by-day audit tool and the multidisciplinary team membership but not the 49-day treatment target.