Lung screening if you have smoked

You gave up smoking years ago, or you still have the odd one, and the thought of your lungs keeps coming back. Perhaps a friend has just had a scan, or a birthday has made those years feel heavier. You'd like to know where you stand, without a lecture.

The useful question is which test suits the lungs you have now. A chest X-ray, a breathing test called spirometry and a low-dose CT scan each look at something different. Our three lung packages are built around them: Essential at £395 with a chest X-ray, Advanced at £999 with low-dose CT, and Elite at £1,599, which adds a blood test to that CT.

If you already know you want a doctor-led look, you can book lung screening at our Harley Street clinic without a GP referral. Every package includes a consultation, an examination, spirometry, imaging that changes by tier, and an in-person review of your results. The Health Screening Clinic has carried out doctor-led respiratory assessment at 117a Harley Street since 1984 and is CQC registered.

If you've coughed up blood, or have new unexplained breathlessness, chest pain, a voice that has changed and stayed changed, or a worsening cough, see your GP promptly. NICE suspected-cancer guidance (NG12) refers people aged 40 and over with unexplained coughing of blood (haemoptysis) urgently. It also uses an urgent chest X-ray when cough, fatigue, breathlessness, chest pain, weight loss and loss of appetite come together, especially in anyone who has ever smoked. If you're very unwell, call 999 or go to A&E.

Which lung test answers which question?

Spirometry is the breathing test. You blow hard into a tube, and it measures how much air your lungs hold and how fast you can push it out. It can flag an obstructive pattern, where the airways are narrowed, or a restrictive one, where the lungs can't fully expand. It tells you a lot about function, but it can't see a nodule.

A chest X-ray is a single flat picture. It can show larger structural change, a collapsed area of lung, obvious masses and some bony findings. NICE still uses it first for many combinations of symptoms. It is less sensitive than low-dose CT for small nodules, and that's the gap the CT fills.

Low-dose CT takes many thin slices through the chest, so it can find the small nodules a flat film misses. It uses ionising radiation, at a lower dose than a standard diagnostic CT. MRI is a superb scan for many organs, but healthy lung is mostly air, and MRI gives only a weak look at lung tissue (the parenchyma). That includes the torso series on a full-body MOT, so for the lungs, CT or X-ray is the better choice.

Essential, Advanced and Elite lung packages

The Essential lung screen costs £395. It includes a consultation and physical examination, spirometry, a chest X-ray and an in-person review of the results. It will miss the small nodules that low-dose CT is designed to find, which is why the next tier swaps the film for a scan.

The Advanced lung screen costs £999. It keeps the consultation, examination and spirometry, replaces the chest X-ray with low-dose CT of the chest, and still includes an in-person review. This is the change that matters if small nodules are your worry. CT often finds incidental nodules, and most of them are not cancer. British Thoracic Society guidance sets out how nodules are measured and watched. Your reviewing doctor will say whether a nodule needs a repeat scan, a different test, or no action.

The Elite lung screen costs £1,599. It includes everything in Advanced and adds an EarlyCDT lung blood test, which looks for autoantibodies that can be associated with lung cancer. Think of it as a clue rather than an answer: it can be negative when disease is present and reactive when it isn't. That's why it is always read alongside the CT, the spirometry and the examination.

Most results for these packages are ready in three to five working days, though specialist tests such as EarlyCDT can take longer. You then come back for a face-to-face review, where anything flagged on the film or the bloods becomes a plan.

How does this fit with the NHS lung programme?

In 2022 the UK National Screening Committee recommended targeted lung cancer screening with low-dose CT for people aged 55 to 74 at high risk. It found screening reduced lung-cancer deaths when the programme was resourced and quality assured, with support to stop smoking alongside. Invitations go to people the NHS identifies as high risk, rather than to everyone who has ever smoked.

In England this began as the Targeted Lung Health Check programme, now part of the NHS England Lung Cancer Screening Programme. The NHS decides who is eligible, and a private scan is a separate assessment that won't enrol you, so if an invitation arrives, take it up as well. NICE's lung cancer guideline (NG122) covers diagnosis and treatment rather than screening, while NG12 covers symptoms. A private low-dose CT is extra imaging, read by a doctor.

Is the chest X-ray in a Health MOT the same as lung screening?

The Advanced Health MOT costs £999. It's a wide preventative visit: examination, metabolic bloods, hormones, spirometry, VO2 max, a chest X-ray and DEXA when clinically indicated, plus four GP appointments over 12 months, shareable with immediate family. Its chest film is the same kind of picture as Essential lung screening, which makes it a good baseline rather than low-dose CT or a lung-cancer package.

If cholesterol, thyroid, bone density when indicated and an all-round baseline are the point, a Health MOT fits well. If small nodules after years of smoking are the worry, the Advanced lung screen is the one with the CT, and the two can sit side by side. Higher tiers add other things: the Elite MOT adds ultrasound and tumour markers for other organs (CEA isn't a lung screen), and the Ultimate MOT adds MRI covering the torso among other regions.

What your results can tell you

A normal chest X-ray means the film, on that day, didn't show a change the reporter judged important enough to flag. A normal low-dose CT means no nodule or other finding was reported at the threshold used, and very small lesions can sit below it. Cancers do appear between scans in every screening programme. As the UK National Screening Committee puts it, screening tests tend to be simple rather than very accurate, and they often lead to further tests.

A nodule, a scar or an enlarged node is a finding rather than a diagnosis, and often the next step is a follow-up scan. False positives lead to extra scans, and false negatives can give false reassurance. Paying privately removes neither, so new symptoms are always worth checking, even after a good report.

Spirometry outside the predicted range needs the same care, because technique, effort, asthma, COPD and infection all move the numbers. If you still smoke or vape, tell the doctor. The appointment is about your lungs rather than a stop-smoking programme, but the doctor is happy to talk about stopping if you'd like.

Getting ready for your appointment

• Your smoking history in years and, if you know it, in pack-years.
• Any previous chest X-rays or CT reports, and the names of your inhalers.
• Anything new, such as coughing blood, losing weight or getting breathless on a flight of stairs. Tell the doctor, because it changes what happens next.
• Clothes you can breathe deeply in, for the spirometry.
• Your regular inhalers: keep taking them unless you've been told otherwise, and carry on with your other medicines as normal.
• A question for the doctor: how will any nodules be measured, and who will explain the report?

Allow three to five working days for results, and keep your review appointment. To go ahead, see the packages on the lung cancer screening page, book online or call The Health Screening Clinic on 020 7183 7056.

If a scan turns up something nobody expected, read incidental findings on a private scan. To weigh organ packages against wider screening, see whole-body cancer screening versus an organ package.

Frequently asked questions

I have smoked. Which lung test should I book?

It depends on what you want to know. Essential at £395 is an examination, spirometry and a chest X-ray. Advanced at £999 swaps the X-ray for low-dose CT, which is better for small nodules, and Elite at £1,599 adds an EarlyCDT lung blood test on top of that CT. For lung tissue, CT and X-ray see far more than MRI, and the chest film in an Advanced MOT isn't an LDCT package.

Will this enrol me in the NHS targeted lung programme?

It's a separate assessment. The UK NSC recommended targeted LDCT screening for people aged 55 to 74 at high risk, and NHS England runs it as a national programme with its own eligibility rules. If you're invited, take it up as well.

Is a chest X-ray enough after years of smoking?

A chest X-ray shows larger changes and is the film NICE uses first for many symptom combinations. Low-dose CT is more sensitive for small nodules, so pick the picture that matches your question rather than assuming the cheaper film does the same job.

Does a normal LDCT mean I don't have lung cancer?

It means the scan that day didn't show anything the reporter flagged. Screening can miss disease, so get any new symptoms checked, even after a reassuring report.

What is the EarlyCDT blood test for?

It's an autoantibody blood test that comes with the Elite lung package. It gives a clue rather than a diagnosis or an all-clear, so the doctor always reads it with your imaging and examination.

I am coughing blood. What should I do?

See your GP today. NICE NG12 refers people aged 40 and over with unexplained coughing of blood urgently for suspected cancer. If you feel very unwell, call 999 or go to A&E.

Do I need a GP referral?

No. You can book yourself in at 117a Harley Street, where the clinic has been since 1984 and is CQC registered. If you have symptoms, see your GP as well.

Sources

• UK National Screening Committee. Lung cancer
• NICE. Suspected cancer: recognition and referral (NG12)
• NICE. Lung cancer: diagnosis and management (NG122)
• NHS. Lung cancer
• UK National Screening Committee. Principles of screening
• General Medical Council. Medical register, Mohammad Bakhtiar, 4694470

Written By

Stephen Lingam

Managing Director

Managing Director of Medical Express Clinic and the Health Screening Clinic since 1984. Over 40 years of operational experience in private healthcare on Harley Street, overseeing patient care, clinical standards, and service delivery.

Medically Reviewed

Dr Mohammad Bakhtiar

MD, PhD, LRCP, MSc, DHMSA

Clinical Lead

GMC: 4694470

Leading our clinical team with a focus on comprehensive men's health and preventative oncology protocols.

Last reviewed: 25/09/2026