Nordic Thoracic Oncology Group

Nordic collaboration on lung cancer screening and pulmonary nodule management

The Nordic Thoracic Oncology Group (NTOG) supports cross-country collaboration on two closely connected areas of lung cancer care: lung cancer screening and pulmonary nodule management.

Across the Nordic countries, national and regional screening pilots are generating important evidence on how low-dose CT screening could be implemented in real-world healthcare systems. These initiatives address key questions such as participant selection, risk-based screening, radiology workflows, management of incidental findings, integration of smoking cessation, use of artificial intelligence, and the resources required for sustainable national programmes.

At the same time, NTOG members are working toward a Pan-Nordic approach to pulmonary nodule follow-up. Pulmonary nodules are commonly detected both in screening programmes and in routine clinical imaging. Harmonised Nordic guidance could help improve consistency, reduce unnecessary variation, support earlier detection of lung cancer, and make follow-up pathways clearer for clinicians and patients.

Why this matters

Lung cancer screening and nodule management are closely linked. Screening programmes identify nodules in people at increased risk of lung cancer, while routine CT imaging already creates a large “de facto screening” population across healthcare systems. Without clear and consistent follow-up pathways, this can lead to unnecessary referrals, patient anxiety, variation in care, and inefficient use of specialist resources.

Nordic collaboration can help answer practical implementation questions:

How should people at increased risk of lung cancer be identified?
Which risk models and eligibility criteria are most appropriate for Nordic populations?
How should pulmonary nodules be reported and followed?
Which findings require specialist referral, and which can be managed within structured follow-up?
How can incidental findings be handled safely without overburdening healthcare systems?
What role should radiologists, pulmonologists, primary care, and multidisciplinary teams have?
How can artificial intelligence and registry data support screening and follow-up?
How can Nordic countries learn from each other while adapting to local healthcare systems?

Lung cancer screening in the Nordic countries

Nordic countries are currently at different stages of lung cancer screening evaluation and implementation. Screening pilots in Norway, Sweden, Finland, and Denmark are testing different models for recruitment, eligibility, low-dose CT imaging, radiology reporting, follow-up, and integration with clinical care.

Early experience highlights several important themes:

Risk-based selection is central to identifying people who may benefit from screening.
Radiology workflow is a major factor in whether screening can be scaled sustainably.
Clear referral thresholds are needed to avoid unnecessary specialist visits.
Incidental findings must be managed in a structured and clinically meaningful way.
Smoking cessation support should be integrated into screening pathways.
Artificial intelligence may support scan interpretation, workflow efficiency, and future personalised screening intervals.
Patient communication must be clear to reduce anxiety and misunderstanding around benign findings.

Nordic pilots also show that implementation requires more than CT capacity. Screening programmes need coordinated systems for invitation, eligibility assessment, scan reading, follow-up decisions, patient communication, data collection, and quality assurance.

Toward a Pan-Nordic pulmonary nodule guideline

NTOG members have identified strong interest in developing a shared Nordic framework for pulmonary nodule management. The aim is to create a concise and implementable consensus document that can support harmonised follow-up across countries while allowing clinical flexibility.

A Pan-Nordic pulmonary nodule guideline could support:

More consistent nodule follow-up protocols
Clearer diagnostic pathways
Better communication between radiology and pulmonology
Reduced unnecessary referrals and investigations
Improved early lung cancer detection
Shared Nordic education and quality improvement
A stronger foundation for registry-based research and future screening programmes

The proposed work will focus on nodule follow-up and diagnostic pathways, rather than treatment decisions for confirmed cancer. Important clinical questions include size thresholds, management of subsolid and ground-glass nodules, duration of follow-up, risk prediction, volumetry, artificial intelligence, and how patient factors such as age, frailty, comorbidities, and overall cancer risk should influence decisions.

A practical Nordic care model

Meeting discussions highlighted the need for models that are both clinically safe and operationally realistic. A future Nordic approach may combine:

Structured radiology reporting
Conditional follow-up recommendations
Short multidisciplinary discussions for selected cases
Standardised patient communication
Clear escalation pathways from administrative staff to nurses and physicians
Local pulmonology involvement when malignancy is suspected
Centralised expertise where appropriate
Use of existing registries and aggregated data where possible

The goal is not to create unnecessary complexity, but to develop a practical framework that supports high-quality care across different Nordic healthcare systems.

Data, registries, and future research

Nordic health data systems offer important opportunities for research on lung cancer screening, pulmonary nodules, diagnostic pathways, and outcomes. However, successful collaboration requires common definitions, structured data collection, and realistic approaches to privacy, consent, and data access.

Key priorities include:

Harmonised terminology for solid, part-solid, and non-solid nodules
Common definitions for follow-up and clinical outcomes
Improved use of cancer registries and local screening databases
Evaluation of artificial intelligence for scan interpretation and data extraction
Long-term development of pooled or federated Nordic datasets
Research on patient outcomes, resource use, cost-effectiveness, and equity

Next steps

NTOG members plan to continue Nordic collaboration on lung cancer screening and pulmonary nodule management. A proposed working group will include pulmonology and radiology expertise from each Nordic country, with the aim of developing a practical consensus document and future joint publication.