Norwegian Lung Cancer Registry

Summary from the annual report 2025

This annual report from the Norwegian Lung Cancer Registry is based on data collected by the Cancer Registry of Norway (CRN). Data sources include individual reports from clinicians and pathologists as well as data from other national registries.

Patients diagnosed with, treated for, and/or deceased due to lung cancer up to 31.12.2025 are included. Cancer Registry of Norway is estimated to include 99.3% of all Norwegian cancer patients. The number of patients diagnosed with lung cancer in 2025 was 3373, a slight reduction from the all-time high of 3466 cases in 2022. This is probably coincidental but may also be a hint of the anticipated decline in incidence due to less smoking in the population. There is no significant sex difference, although there are slightly more cases among women (1732) compared to men (1641).

There has been a significant increase in annual cases, especially among women in the last 20 years. In the same time period, the median age at diagnosis has increased from 70 to 74 years. This is due to a declining incidence rate in persons below the age of 70. 

For patients over 70 years, the incidence rate is still high, slightly higher among men than women. Among the older individuals there has been a small annual decrease in incidence rates among men in contrast to an increase for women albeit with a trend toward plateauing these last years. The apparent discrepancy between the increase in total numbers and the declining incidence rates is due both to an increase in citizens and an aging population.

The national survival rate has tripled since the turn of the century with a 5-year relative survival rate now reaching a newrecord level at 32.6%, even higher for women at 36.5% . As a result, the prevalence of lung cancer patients alive is more than three times higher by the end of 2025 compared to two decades ago. The combination of higher survival rates, increasing prevalence and the expanding availability of new treatment options all generate a higher burden on the health system. 

Patients with adenocarcinoma have a better survival than other histologies. Having a treatable EGFR or ALK mutationresults in a further survival benefit regardless of stage at diagnosis. Median survival amongpatients with stage IV lung cancer remain slow; however, the 75th percentile of survival for patients with stage IV NSCLC doubled between 2015 and 2023, reaching 24 months. 

In 2025 the proportion of potentially curable patients (stages I–III and ECOG 0–2) evaluated at a multidisciplinary team meeting was 94.0%, and 90.5% in this group underwent PET/CT as part of their diagnostic work-up, both parameters slightly lower than the national target. Of patients in stages IB–III and ECOG 02, 54.1% had EBUS/EUS performed. EBUS/EUS is becoming increasingly important to differentiate between operable and non-operable patients, as well as surgery with or without neoadjuvant therapy. The overall proportion of lung cancer patients receiving treatment with curative intent in 2025 was 37.8%. 

The use of video assisted thoracic surgery (VATS) or robot assisted thoracic surgery (RATS) continues to increase and was performed in 91.7% of patients in stage  I in 2025. The quality of surgery is high,with a national 30-day postoperative mortality of 1.0%. A new national target for the quality of surgery was introduced in 2023, which is resection of subcarinal lymph nodes. There is considerable variation in the numbers between the six centres performing lung cancer surgery in Norway. 

Regarding medical treatment, hospitals serving 90% of the population have systems that automatically report chemotherapy or immune oncology to the Cancer Registry of Norway. Data regarding targeted oral therapy (protein kinases) is available nationally from registration of prescriptions. The use of immune oncology is increasing at the same levels in different parts of Norway. This indicates homogeneity in the availability of modern treatment options. 

Patient reported outcomes (PROMs) are still somewhat new in the registry, but some data are presented in the report. Data are collected through electronic forms filled in by the patients themselves. The number and percentage of answers are still low, but improving, with 38.3% of lung cancer patients responding (table 2.6). The quality of life is lower in lung cancer patients regardless of age compared to a matched control population. But there is an improvement over time where lung cancer patients report less pain and better mental health by 18 months than by the time of diagnosis. 

Data regarding smoking habits show that 24% of patients were still daily smokers at the time of diagnosis, and 13% were never smokers. In comparison the numbers among the matching controls were 6% and 48%. In the oldest age group, >75 years, there were fewer active smokers when diagnosed than among the age groups 18–64 and 65–74 years, 15% vs 28% and 27% respectively.

Inthis year’s report an extra emphasis has been put on lungcancer among the older patients. Several figures show the difference between patient younger or older than 75 years of age at time of diagnosis.

The distribution and change over time of histological subtypes are found to be the same in both groups except a small but noticeable higher frequency of squamous cell carcinoma in the elderly.

The elderly are found to undergo surgery less often, even in stage I, and are instead treated with stereotactic radiation. In contrast a higher proportion of elderly with comorbidities than without, according to the Charlson Comorbidity Index, are found to receive treatment with curative intent. Probably because their already established contact with the health system increases their chance of getting an early cancer diagnosis.

Furthermore, the data show that the elderly are more prone to be treated with stereotactic radiation without a proper histological verification oftheir tentative stage I cancer. In contrast, they do not receive palliative radiation as often as their younger counterparts.