Targeted screening is vital to combat lung cancer in Wales

Lung cancer remains the biggest cancer killer in Wales – claiming more lives than breast and bowel cancer combined. Shockingly, nearly half of lung cancer cases in Wales are diagnosed at Stage 4, when the chance of survival plummets to just 15%, compared to 85% if caught at Stage 1. 

These stark statistics underscore the urgent need to do things differently. The single most important action we can take to improve cancer outcomes is early detection, when treatment is far more effective. And while headlines often focus on major scientific breakthroughs, most progress comes through a steady accumulation of smaller, meaningful advances in detection, awareness, and treatment.

As I come to the end of my tenure as Chief Executive of Tenovus Cancer Care, I find myself reflecting on the last six years. There is much to celebrate, but few moments have struck me more deeply than the recent announcement from the Welsh Government: the introduction of a national lung cancer screening programme for Wales.

But to truly save lives, we must ensure the programme reaches those most in need – and that means tackling the inequalities that have long shaped lung cancer outcomes in Wales.

This milestone is one Tenovus Cancer Care has long campaigned for – alongside fellow cancer charities and health professionals – recognising its potential to transform outcomes for patients. The programme will target people aged 55 to 74 with a history of smoking, the most at risk group, and integrate smoking cessation support to not only detect cancer early but help reduce future risk.

But to truly save lives, we must ensure the programme reaches those most in need – and that means tackling the inequalities that have long shaped lung cancer outcomes in Wales.

Tackling health inequalities is core to our mission at Tenovus Cancer Care. We recognise that not everyone experiences cancer equally, and this is especially true when it comes to lung cancer. 

People living in deprived areas are 2.75 times more likely to develop it. Even more concerningly, mortality differences between more and less affluent groups have widened over time.

There are several reasons why people develop lung cancer but the most common is through smoking. In fact, smoking is thought to be the biggest driver of these inequalities. There are several well-known reasons why smoking is more common among more deprived communities. It is often a response to stress, is passed down through generations, and can be wrongly perceived as more widespread than it is.

But it is more than just smoking behaviour that drives these inequalities. Quitting also presents greater challenges in these communities, symptom awareness is lower and there can be a greater reluctance to seek help from the healthcare system.

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Smoking cessation services must improve their engagement and tailor their support for people in deprived areas, helping them overcome these barriers and make quitting achievable.

Closing these gaps in support is essential, because without a holistic approach, Wales will continue to fall behind in tackling cancer.

Wales lags behind our European counterparts in cancer survival rates. Lung Health Checks offer a clear way to change this. The evidence is overwhelming – the sooner the programme is introduced, the more lives will be saved.

However, previous screening programmes have shown that a one-size-fits-all model could do more damage and actually increase health inequalities. Uptake tends to be lower in more deprived communities, who face the greatest risk. That’s why targeted outreach is essential, especially for those in more deprived areas.

We must make sure there are no judgments about lifestyle choices or smoking habits when going for a lung health check. I want to see a change in the way lung cancer is viewed, so that more people feel they can seek medical advice as soon as they have concerns, leading to earlier diagnosis and better outcomes if caught early.

We can learn from England’s trials to better reach those who need screening most. As we prepare for a future where lung cancer screening is a reality in Wales, addressing the root causes of inequality must remain at the forefront.

Despite its very serious prognosis, lung cancer is not a death sentence. Everyone deserves the same chance of survival, and we want to make sure as many people as possible are picked up early, whatever their socioeconomic circumstances.

But clinical appointments come with their own challenges, particularly in deprived areas, where barriers include fear of judgement, fear of lung cancer as a death sentence, time off from work, caring responsibilities, and transport.

To achieve that, we must confront the realities driving unequal outcomes. There are three main reasons why deprivation leads to both higher lung cancer rates and poorer survival:

• Smoking prevalence is significantly higher in deprived areas and causes more than 70% of lung cancer cases.
• Delayed diagnosis is common due to lower awareness of symptoms and practical or emotional barriers to seeking help.
• Limited treatment options available, due to co-morbidities and the lack of specialist services locally.

These factors all combine to mean that the most deprived in our society are least likely to receive any type of treatment for their lung cancer.

The Welsh Government has outlined a strategy for Wales to become smoke-free by 2030, aiming to reduce smoking rates from the current levels of 18% of the population to less than 5%. Whilst smoking rates are declining, the relationship between deprivation and smoking must be understood in order to reach this ambitious target.

Introducing targeted Lung Health Checks with low-dose CT (LDCT) screening in Wales could prevent over 20% of lung cancer deaths amongst those screened and improve outcomes for many more patients. But clinical appointments come with their own challenges, particularly in deprived areas, where barriers include fear of judgement, fear of lung cancer as a death sentence, time off from work, caring responsibilities, and transport.

Looking ahead, Public Health Wales will likely utilise mobile scanning units to ensure equitable access across all parts of Wales, addressing the geographical disparities in healthcare access. Funding of £2.3 million has been committed for 2025-26 to expand the project team and initiate the programme, with an estimated annual cost of £13 million once fully implemented.

This decision marks a significant step forward in cancer services in Wales, demonstrating a commitment by the Welsh Government to preventative health and early intervention. 

This achievement would not have been possible without the work of some key people, such as Dr Sinan Eccles, Clinical Lead of the Lung Health Check Programme, and Consultant Respiratory Physician at the Royal Glamorgan Hospital. The determination of a core team of people from the public, private and third sectors will ensure the people of Wales are given equitable access to lung screening. It has been a pleasure to work with this team to get to this point.

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Tenovus Cancer Care convened a group that provided the funding needed for an operational pilot, led by Dr Eccles, within an area of Cwm Taf Morgannwg Health Board, which has a higher-than-average lung cancer rate. The pilot detected and treated two-thirds of diagnosed lung cancers at an early, more treatable stage. 

“The evidence that targeted LDCT screening for lung cancer is clinically- and cost-effective is now overwhelming. Development of a targeted lung cancer screening programme is the single most important change Wales could make to affect cancer mortality in the coming years,”says Dr Eccles.

Tenovus Cancer Care stands ready to support NHS colleagues to deliver this programme swiftly so that as many people as possible benefit by the 2027 target for implementation. I’m just delighted to have had such a central role in reaching this decision, knowing that the lung cancer screening programme will change lives for generations to come. 

It means earlier diagnoses, better outcomes, and more time for families to share life’s moments together. It’s the kind of impact Tenovus Cancer Care always strives for – evidence-driven, lifesaving, and deeply human.

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