Screening and nodule management belong together
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 lung cancer screening pilots are providing important evidence on how low-dose CT screening can be implemented in real-world healthcare systems.
These initiatives address participant selection, risk-based screening, radiology workflows, management of incidental findings, smoking cessation, artificial intelligence, and the resources required for sustainable national programmes.
In parallel, NTOG members are working toward a Pan-Nordic approach to pulmonary nodule follow-up and diagnostic pathways.
Why this matters
Screening programmes and routine CT imaging both create a large population of people with pulmonary nodules requiring structured follow-up.
Lung cancer 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 create practical pathways that are clinically safe, realistic to implement, and suitable for comparison across healthcare systems.
Lung cancer screening in the Nordic countries
Nordic countries are at different stages of screening evaluation and implementation.
Implementation questions
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.
Important questions include how to identify people at increased risk, which eligibility criteria are appropriate for Nordic populations, how incidental findings should be handled, and how AI and registry data can support screening and follow-up.
Operational requirements
Implementation requires more than CT capacity. Screening programmes need coordinated systems for invitation, eligibility assessment, scan reading, follow-up decisions, patient communication, data collection, quality assurance, and smoking cessation support.
NTOG considers that current evidence supports moving toward lung cancer screening in the Nordic countries, provided implementation is resourced, coordinated, equitable, and quality-assured.
Toward a Pan-Nordic pulmonary nodule guideline
The aim is to create a concise, implementable consensus document that supports harmonised follow-up while allowing clinical flexibility.
The idea for a shared Nordic guideline on incidental pulmonary nodules emerged from discussions within the Nordic thoracic oncology and lung cancer community.
Following the NTOG meeting in Gothenburg, existing national guidelines from Denmark, Norway, and Sweden were compared to identify common principles and important differences. This work, coordinated by Torben Riis Rasmussen of the Danish Lung Cancer Group, laid the foundation for a joint Nordic initiative.
Current national guidelines across the Nordic countries are based on broadly similar evidence, but they differ in risk thresholds, follow-up strategies, and organisational pathways.
This variation highlights the need for greater harmonisation in detection, reporting, and early management of incidental pulmonary nodules.
Proposed scope
The proposed work focuses on nodule follow-up and diagnostic pathways, not treatment decisions for confirmed cancer.
A Pan-Nordic pulmonary nodule guideline could support more consistent follow-up protocols, clearer diagnostic pathways, better communication between radiology and pulmonology, fewer unnecessary referrals and investigations, improved early lung cancer detection, and shared Nordic quality improvement.
A practical Nordic care model
The goal is a practical framework that supports high-quality care across different Nordic healthcare systems.
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, selected multidisciplinary discussions, standardised patient communication, and clear escalation pathways.
The aim is not to create unnecessary complexity, but to support local pulmonology involvement when malignancy is suspected and centralised expertise where appropriate.
Data, registries, and future research
Nordic health data systems offer important opportunities for research on screening, nodules, diagnostic pathways, and outcomes.
- Harmonised terminology for solid, part-solid, and non-solid nodules.
- Common definitions for follow-up, diagnostic escalation, and outcomes.
- Improved use of cancer registries and local screening databases.
- Evaluation of artificial intelligence in radiology workflows and nodule management.
- Long-term development of pooled or federated Nordic datasets.
- Realistic approaches to privacy, consent, data access, and national governance.
Next steps
NTOG members plan to continue Nordic collaboration on lung cancer screening and pulmonary nodule management.
Proposed working group
A proposed working group, led by Zaigham Saghir, will include one pulmonologist and one radiologist from Finland, Denmark, Norway, and Sweden.
The group will consult other experts during the work.
This initiative reflects NTOG's broader mission to strengthen Nordic collaboration in thoracic oncology research, support evidence-based care, and improve outcomes for patients with lung cancer.