Lung CT scans for smokers and quitting smoking

Since October 2026, the NFZ (Poland's National Health Fund) has funded a lung cancer screening programme for people over fifty who have smoked cigarettes for many years. The programme is based on a low-dose computed tomography (CT) scan of the chest, done every 12 months without a referral (1, 2). The programme is starting gradually: according to the NFZ, the first patients are expected in the second half of October, and in some regions the scans will probably begin in November (2).

A CT scan can detect lung cancer earlier, when the chances of successful treatment are higher (2). However, it does not reduce the risk of developing the disease. That risk goes down only after you stop smoking. The programme also includes a smoking cessation intervention, meaning help to stop smoking, which the doctor provides to every person who smokes, whatever the result of the scan (1).

The time between signing up for the scan and discussing the result is a good moment to start treatment for nicotine dependence. In studies of people who came for a lung CT scan, those who were offered help straight away were more likely to quit smoking than those who were only told where to look for it (3, 4).

In brief

• A free lung CT scan in the NFZ programme is done without a referral every 12 months in people aged 55-74 with a smoking history of at least 20 pack-years (for example, a pack a day for 20 years) who smoke or stopped smoking no more than 15 years ago. People aged 50-54 qualify only if they have an additional risk factor.
• A CT scan does not protect you from lung cancer. In the US NLST trial, the risk of dying from lung cancer in people who kept smoking was more than twice as high as in former smokers, including in the group screened with CT.
• Studies do not clearly show whether the scan itself prompts people to quit smoking. There is better evidence for help offered at the time of the scan: several sessions with a specialist combined with medication.
• Quitting smoking does not exclude you from the programme. People who stopped smoking no more than 15 years ago and meet the other criteria continue to have a CT scan every 12 months, because the risk of lung cancer falls gradually after quitting.

Who can have a free lung CT scan in the NFZ programme?

The lung cancer screening programme is open to people aged 55-74 with a smoking history of at least 20 pack-years who still smoke or stopped smoking no more than 15 years ago. People aged 50-54 with the same smoking history must also have at least one additional risk factor (1).

Pack-years are calculated by multiplying the number of packs smoked per day by the number of years of smoking. A pack a day for 20 years is 20 pack-years, and so are two packs a day for 10 years (2).

Additional risk factors that make people aged 50-54 eligible for the scan (1):

• at least 2 years of work involving exposure to silica, beryllium, nickel, chromium, cadmium, asbestos, arsenic compounds, diesel exhaust fumes, smoke from burning hard coal or soot
• exposure to radon
• previous lymphoma, head and neck cancer or bladder cancer
• lung cancer in a parent, brother, sister or child
• chronic obstructive pulmonary disease (COPD)

When should you see a doctor instead of having a lung CT scan in the NFZ programme?

Screening is used to detect lung cancer in people who have no symptoms that could point to it. People who are coughing up blood or have hoarseness, unintentional weight loss or a cough lasting longer than 8 weeks are excluded from the programme (1). With symptoms like these, you need to see a doctor, because diagnostic tests are needed, not screening.

The programme also does not cover (1):

• people who have had a CT scan of the chest in the last 12 months
• people diagnosed with lung cancer or another cancer involving the respiratory system, including during the 5-year follow-up after the end of treatment
• people with contraindications to a CT scan, for example those whose general condition does not allow diagnostic tests

People who have been treated for lung cancer can be screened in the programme once the five-year follow-up has ended, if they meet the age and smoking criteria (1).

In which regions of Poland has the NFZ already signed contracts for free lung CT scans?

The NFZ is signing contracts with healthcare facilities for the period starting on 1 October 2026. According to an NFZ announcement updated on 20 October 2026, the first contracts were signed in the Świętokrzyskie, Lesser Poland (Małopolskie) and Greater Poland (Wielkopolskie) voivodeships, and the first patients are expected in the programme in the second half of October. Further tenders are still being awarded. In the Lower Silesian (Dolnośląskie), Opole and Podlaskie voivodeships, they had to be repeated, so the programme will probably start there in November. The NFZ says that a list of facilities running the programme will appear in its "Gdzie się leczyć" ("Where to get treatment") search tool (2).

How the free lung CT screening programme works

The programme consists of an eligibility appointment, the CT scan, a results appointment and further follow-up scans. Help to stop smoking is part of the results appointment, and everyone who smokes is entitled to it (1).

1. Eligibility appointment. The doctor takes your medical history and checks whether you meet the programme criteria. At this appointment you may see a pulmonologist (lung specialist), a thoracic surgeon, a GP (family doctor), an internist or an occupational health doctor.
2. Low-dose CT scan of the chest. The radiologist reports significant findings in the lungs, in the mediastinum (the space between the lungs), in the heart and in the coronary arteries. Any lung nodules found are assigned to a category according to the 2022 version of the Lung-RADS system, and the category determines what happens next.
3. Results appointment. The doctor discusses the result and gives recommendations. A non-smoker with a negative result can discuss it during a remote consultation (teleporada). If the result is inconclusive or positive, the appointment is in person at the facility, and the patient receives a referral for a follow-up CT scan or for further diagnostic tests.
4. Next CT scan. The scan is repeated after 12 months, or at a time set by the doctor if the result needs monitoring.

The regulations do not specify what the smoking cessation intervention should consist of (1). A 2025 Polish expert consensus recommends that a screening participant who smokes should receive help to stop smoking at the very first appointment. After that, it recommends sessions with a specialist, medication if there are no contraindications, and further contact throughout the programme, including remote consultations (5). So it is best to mention that you want to quit right at the start, at the eligibility appointment.

What are the benefits of quitting smoking for someone having lung CT scans?

A CT scan makes it possible to detect lung cancer earlier, while quitting smoking reduces the risk of developing it and of dying from it (6, 7).

In the NLST trial, 53,454 high-risk people had a low-dose CT scan or a chest X-ray once a year for 3 years. In the CT group, lung cancer mortality was 20% lower than in the X-ray group (8).

In a further analysis of the NLST data, the risk of dying from lung cancer in people who kept smoking was more than twice as high as in former smokers, both in the CT group and in the X-ray group. According to the authors, 7 years without smoking reduced lung cancer mortality to a similar extent as CT screening, and the combination of many years without smoking and CT screening was linked to the greatest reduction in lung cancer mortality (6). This was an observational analysis. Participants decided for themselves whether to quit, so the result does not prove that quitting caused the whole difference.

The CT report also covers findings in the heart and coronary arteries (1). Quitting smoking reduces the risk of heart disease: after a year without cigarettes, the risk of coronary heart disease is about half that of someone who smokes (9). Our article how long does the average smoker live? describes how many years of life people gain if they quit after fifty or after sixty.

Why is a lung scan a good time to quit smoking?

At the time of a lung scan, motivation to quit smoking may be higher, and help offered straight away at the scan increases the chance of quitting (3, 5). Studies do not clearly show whether the scan alone, without such help, prompts people to quit (10, 11).

In the Danish DLCST trial, 4,104 current and former smokers were randomly assigned to an annual CT scan for 5 years or to a group with no scans. Both groups received brief advice on quitting smoking. Overall, the proportion of former smokers rose from 24% to 37%, and the difference between the groups was not statistically significant (5, 10). In the UK UKLS trial involving 1,546 smokers, a questionnaire was sent about 2 weeks after participants received their CT result or were told they had been assigned to the group without a scan. In this questionnaire, 14% of respondents who had had a scan and 8% of those without a scan reported having quit since the start of the trial, but after about 2 years the difference was smaller and uncertain (11).

What helps people being screened for lung cancer to quit smoking?

In a 2023 meta-analysis, help to stop smoking provided during lung screening increased the chance of quitting compared with usual care (odds ratio 2.01). Programmes that included at least three sessions with a specialist were effective. Some of them also included medication, so the result should not be attributed to the number of sessions alone. One or two sessions, or leaflets and take-home materials alone, did not clearly increase the number of people who stopped smoking (3).

In two UK trials, some smokers aged 55-75 who came for a lung check were immediately offered help to stop smoking together with medication. After a year, 12.1% of them were not smoking, compared with 4.7% in the group who were only told where to look for help. Abstinence was confirmed by measuring carbon monoxide in exhaled breath (4).

In an Italian trial of 869 heavy smokers taking part in a screening programme, 32.1% of people taking cytisine and receiving counselling did not smoke for the whole year, compared with 7.3% of those receiving counselling alone. People taking cytisine reported side effects more often, mainly stomach and bowel complaints (12). In this trial, cytisine was taken for 40 or 84 days, so the result does not directly apply to the 25-day course described in the Polish summaries of product characteristics (SmPCs).

What should you do after your lung CT result if you still smoke?

The CT result determines when the next scan takes place and whether further tests are needed, but participants who smoke are entitled to help to stop smoking whatever the result (1).

Can you keep smoking if your lung CT found nothing suspicious?

A negative result does not mean that smoking is safe. It means that no abnormalities suspicious of lung cancer were found on the day of the scan. It does not rule out developing the disease in the following years, which is why the next CT scan in the programme is done after 12 months (1). Other findings described in the report, for example in the heart, may need a separate check-up with a doctor. In the NLST trial, people with a normal result quit smoking less often than people whose scan showed abnormalities. The more serious the abnormality on the previous scan, the more often participants stopped smoking, and the differences persisted for up to 5 years after the last scan (13).

What does it mean if a lung nodule needs monitoring?

A lung nodule is a small abnormality visible on a CT scan. Most nodules found in screening are not cancer. In the NLST trial, 24.2% of CT scans done over three screening rounds had a positive result, and 96.4% of these results turned out to be false positives, meaning the abnormality found was not cancer (8). In the Dutch-Belgian NELSON trial, which measured nodule volume, 9.2% of screening CT scans in men gave an indeterminate result, after which an additional CT scan was done, and 2.1% gave a positive result, after which participants were referred for further diagnostic tests (14).

The doctor sets the date of the follow-up scan according to the nodule's Lung-RADS category (1). You can use the wait for this scan to start treatment for nicotine dependence. Anxiety before the next scan can make the urge to smoke stronger, so it is better to already have a medicine chosen with your doctor and a plan for the moments when the urge comes. Our article on nicotine cravings explains how to cope with a sudden urge to smoke when you are stressed.

Is it worth quitting smoking during further tests after a lung CT scan?

Yes. A referral for further tests means that the abnormality in the lung needs to be examined more closely, but it is not yet a diagnosis of cancer (1, 8). Quitting smoking also matters if lung cancer is diagnosed. In a review of observational studies, people with early-stage non-small cell lung cancer who kept smoking had an almost three times higher risk of death from any cause than people who quit after diagnosis. The authors rated this evidence as preliminary (15).

Do you still need lung CT scans after you quit smoking?

Yes, as long as you meet the programme criteria. The programme covers people who stopped smoking no more than 15 years ago (1). The risk of lung cancer falls gradually, over many years, after quitting (7).

In the US Framingham study, the risk of lung cancer in heavy smokers who then quit was 39% lower in the first 5 years after quitting than in people who kept smoking. However, even after 25 years without cigarettes, this risk remained more than three times higher than in people who had never smoked (7).

So quitting before the eligibility appointment does not rule you out of screening. At the appointment, you need to tell the doctor how many years you smoked, how many cigarettes a day, and when you had your last cigarette.

How do you start treatment for nicotine dependence before a lung CT scan or after the result?

It is best to start with an appointment with a doctor, who will choose a medicine taking into account your health conditions and the other medicines you take, and to plan several sessions with a specialist, such as a psychologist or an addiction therapist (3, 5).

1. Tell the doctor at your programme appointment that you want to quit. At the eligibility or results appointment, ask what the smoking cessation intervention involves at that facility and whether it includes medication and further sessions.
2. Set a quit day. With cytisine treatment, you need to stop smoking by day 5 of the course at the latest (16). Our article on the 25-day cytisine course describes the dosing schedule.
3. Tell the doctor about all the medicines you take. After you stop smoking, blood levels of some medicines, such as theophylline or clozapine, may rise (16). Our article cytisine from the pharmacy or a course with a doctor? lists the conditions and medicines for which a cytisine course needs to be agreed with a doctor.
4. Do not swap cigarettes for an e-cigarette, heated tobacco or nicotine pouches. These products still deliver nicotine (5).
5. Book sessions with a specialist for your first weeks without cigarettes. Irritability, anxiety, difficulty concentrating and insomnia after stopping cigarettes are usually strongest in the first week and last 2-4 weeks (17).

Can people over 65 take cytisine?

The Desmoxan summary of product characteristics does not recommend its use in people over 65 because of limited clinical experience (16). The screening programme is open to people up to the age of 74, so for some participants the doctor may suggest a different medicine. For screening participants with no contraindications, Polish experts list nicotine replacement therapy, cytisine, bupropion and varenicline as options (5).

What does the nicotine dependence treatment plan at Nasz Gabinet involve?

The nicotine dependence treatment plan lasts 3 months, and we provide it online, without a referral. It starts with a medical interview in the chat in the Nasz Gabinet app. The questions cover, among other things, your health conditions, the medicines you take and your age. If there are no contraindications, the doctor issues an e-prescription for cytisine. If any answer points to a contraindication, the doctor first reviews your situation and replies to you in the chat. The app reminds you of every dose and counts your smoke-free days. You book a consultation with a psychologist in the app and pay for it separately.

Frequently asked questions

Do you need a referral for a lung CT scan in the NFZ programme?

No. You just need to go to a facility that has a contract with the NFZ for the lung cancer screening programme (2). The doctor at the eligibility appointment decides whether you can have the scan (1).

I've had a cough for a few weeks. Can I have a lung CT scan in the NFZ programme?

If your cough has lasted longer than 3 weeks, you need to see a doctor first. This threshold is given by the UK's National Health Service (NHS), which advises booking an urgent appointment if you are coughing up blood (18). A cough lasting longer than 8 weeks, coughing up blood, hoarseness and unintentional weight loss exclude you from screening, because such symptoms need diagnostic tests (1). Our article quitting smoking day by day describes coughing in the first weeks after quitting smoking.

Is it a good idea to switch from cigarettes to e-cigarettes before a lung CT scan?

No. The Polish expert consensus advises screening participants against replacing cigarettes with e-cigarettes, heated tobacco or nicotine pouches, because this risks keeping them dependent on nicotine or leading them back to cigarettes (5). Our article how to quit vaping explains how to give up e-cigarettes.

What should I do if I smoke but don't meet the criteria for the lung CT programme?

Not being eligible for screening does not mean that smoking is safe. According to the Polish consensus, a smoker who comes for screening but does not meet the criteria should receive advice on quitting smoking or a referral to a tobacco dependence clinic (5).

Sources

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