Lung cancer screening in the Nordic countries: Approaching implementation ahead of the evidence

AIMS: To critically synthesize the evidence of lung cancer screening on lung cancer mortality, adverse effects, cost-effectiveness, and practical implementation, with a focus on the rationale and implications of introducing lung cancer screening in the Nordic countries.

METHODS: We reviewed existing literature on lung cancer screening, primarily drawing on Cochrane reviews, to examine mortality outcomes, adverse effects, cost-effectiveness, and implementation challenges of lung cancer screening.

RESULTS: Chest X-ray lung cancer screening has not been shown to reduce lung cancer mortality, whereas low-dose computed tomography (LDCT) screening has demonstrated a statistically significant reduction in lung cancer mortality in a high-risk population. For all-cause mortality, meta-analyses have shown mixed results depending on which trials are included and the methods used, albeit none of the European trials have revealed a reduction in all-cause mortality. Limited high-quality evidence on the unintended harms of LDCT screening exists but suggests that LDCT screening might cause considerable unintended harm, especially via false positives, incidentalomas, and overdiagnosis. Cost-effectiveness analyses on LDCT screening frequently fail to account for indirect costs, which might lead to an underestimation of the true economic burden of screening. Implementation of LDCT screening presents practical challenges, including reaching the target population and the limited capacity in the healthcare system.

CONCLUSIONS: There is evidence of reduction in lung cancer mortality in a high-risk population screened with LDCT. However, further evaluation is needed to assess the potential unintended harms, the practical implementation within the Nordic healthcare systems, and the environmental impact, including increased CO2 emissions.