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The Staffordshire Targeted lung health check (THLC) project commenced in 2019 and joined the national TLHC programme in 2022. During this period the project used the same eligibility criteria as the national programme: age 55–75 years of age; ever smoker and registered with a GP. During the initial phase of the project people were invited to make an appointment for discussion and assessment of lung cancer risk, this changed later to people opting out of appointments, as this improved uptake in the programme. The lung cancers identified through the screening programme were compared to this individuals that did not participate in the programme, by reviewed the local cancer registry for the GP practices that had been involved in the project at that time, and patients who would have been in the eligible population and would have been offered an invitation to participate.Between 2019 and 2024 the project screened 31,355 individuals, with 34,032 not screened. 252 lung cancers were identified through screening, while 387 lung cancers were identified in the non-screened population.Abstract P167 Table 1Comparing the stage of cancers between the 2 groups there was statistically significant greater risk of developing lung cancer in the group that were diagnosed through the non-screening route. Reinforcing the need to try to reach this group of people who declined enrolment in the TLHC programme, as this group are at a higher risk of developing lung cancer.