Lung cancer screening by low-dose chest CT (LDCT) is now being implemented in the United States, and in Europe it was recently recommended to start planning for implementation. Current lung cancer screening programmes include up to 25 annual LDCTs, plus shorter-term follow-up LDCTs when indicated. However, the choice of a yearly CT scan has not been based on biological mechanisms, and it is questionable whether all persons eligible for lung cancer screening require annual screening. A tailored approach in screening programs to balance potential harms and benefits from screening becomes more and more important when lung cancer screening is performed more widespread. If lung cancer screening participants can be identified at mid-high lung cancer risk that can be followed safely by prolonged screening intervals, reduction of possible physiological harms, radiation exposure and costs can be expected. Different randomized controlled lung cancer screening studies have shown that the baseline screen result can be used to identify a subset of participants with a low 2-year lung cancer probability. These participants may be safely followed after a prolonged screening interval with the optimal screening interval probably between 1 and 2 years until their risk profile changes. In case a new pulmonary nodule appears at subsequent screening, or a small baseline nodule starts growing, participants should always return to annual LDCT screening after the appropriate workup.