Experts have warned that thousands of additional lung cancer deaths in the UK will be a direct result of the pandemic, jeopardising previously hard-won gains in survival. Urgent action is needed according to a report from the UK Lung Cancer Coalition (UKLCC), which estimated that delays in lung cancer diagnoses as a result of COVID-19 lockdowns will increase deaths in the 5 years after diagnosis by 4·8–5·3%.Data from the National Lung Cancer Audit, due to be published in early 2022, are also likely to show that the pandemic has cut curative treatment rates for early-stage lung cancer. The disruption caused by the pandemic puts at risk the progress made towards the target to drive 5-year survival up to 25% by 2025, as well as goals of the UK National Health Service (NHS) Long-Term Plan to diagnose 75% of cancers at stage I or II.To recover, the UK will need to implement a national screening programme at the earliest opportunity, address regional variations in treatment, provide better access to genomic testing and immunotherapy for advanced disease, and take urgent steps to address workforce shortages, the UKLCC concludes in its report.Robert Rintoul (chair of the UKLCC Clinical Advisory Group, Solihull, UK), told The Lancet Oncology that the pandemic has had a “devastating impact” on early diagnosis. “Many of us treating patients with lung cancer have commented that we arre seeing presentations we have not seen since the 1980s or 1990s.”NHS England's targeted Lung Health Checks for 55–74-year-olds who had ever smoked had only just begun when they came to a “grinding halt” in March, 2020, Rintoul explains. These checks have now been expanded to 23 areas of the country, with an aim of two sites in every Cancer Alliance. Some feasibility work is also being done in the devolved nations.“We hope that this will be the forerunner of a national screening programme, and the UK National Screening Committee is looking at this issue at present”, said Rintoul. “The one thing above everything else that would make a difference would be screening. If we can push up the current 25% diagnosed at stage I and II to 40–50%, then long-term survival will go shooting up.”Addressing geographical variations within the UK—particularly with regard to access to curative treatment, such as stereotactic ablative radiotherapy—is also needed, the report warned. The latest National Lung Cancer Audit data show that 81% of patients with early-stage disease received treatment with curative intent, but this proportion varied from 55% to 100%, and 59 health-care provider organisations did not reach the audit target of 80%.Rintoul said that although population demographics will make it harder for some areas to reach the same outcomes, shared learning is necessary. “The National Lung Cancer Audit is going to publish new data at the beginning of next year, using, in part, rapid registration datasets. We need these kind of data so we can be nimble and responsive.”The report calls for more flexibility in implementation of newer molecular-targeted therapies, including frequent updates to the National Genomic Test Directory, and it says none of the ambitions can be met without tackling workforce shortages across the multidisciplinary team. In the short term, training and upskilling existing support staff and assistant practitioners is needed to free up other team members for more specialised tasks.Vidan Masani (chair of the British Thoracic Society Lung Cancer and Mesothelioma Specialist Advisory Group, London, UK; Royal United Hospitals, Bath, UK) said that clinicians were seeing a lot more late-stage, inoperable disease. Turning things around, especially given the uncertainty of the upcoming winter, will be hard, but it is doable, he said. “The biggest impact would be a lung cancer screening programme. This is my personal view, but there is political inertia about this. This is a political and financial decision because the evidence is straightforward.”In addressing regional differences in treatment rates, he said the approach should be one of “carrot, not stick”. Masani added there are currently delays in genomic testing. “Immunotherapy is a game changer; it has shifted the shape of the curve, and access to testing and drugs need to be done in a timely fashion.”Jeanette Dickson (Royal College of Radiologists, London, UK, and member of the UKLCC Clinical Advisory Group) agreed the “25 by 25” target was tough, but achievable, partly depending on how much elective care is disrupted this winter. However, reaching this target will require investment in infrastructure, in staff, and in kit such as CT scanners, she added. “I am very concerned about the workforce figures across the whole multidisciplinary team. People are taking this seriously and do recognise that whatever you want to achieve, you need to have the workforce to do it.”