Jason Rebecca* and Gilbert Vera
In Europe, lung cancer is the most common type of cancer-related death. In high-risk people, screening with Low-Dose Computed Tomography (LDCT) can advance detection and lower lung cancer mortality. To date, however, only four European nations—Poland, Croatia, Italy, and Romania— have vowed to conduct targeted LDCT screening on a large-scale. This paper assesses critical elements required for the successful deployment of screening programmes throughout Europe using a health systems approach. For 10 nations (Belgium, Croatia, France, Germany, Italy, the Netherlands, Poland, Spain, Sweden, and the United Kingdom), recent literature on LDCT screening was read. This was done in addition to 17 semi-structured interviews with local specialists. Research results were compared to lung cancer screening-specific health systems architecture. Although the European policy environment is very diverse, possible implementation hurdles are widespread and consistent with those identified for other cancer screening initiatives. While ensuring uniformity in screening quality and safety across all screening facilities, system aspects are also crucial. These include of having the right kind of data infrastructure, employing targeted recruitment techniques that guarantee participation equity, having enough resources and workforce training, fully integrating screening into multidisciplinary treatment pathways, and offering smoking cessation programmes. Important factors to take into account include stigma and underlying beliefs that lung cancer is a disease that one causes themselves. Governments now have a rare opportunity to construct effective, efficient, and equitable lung cancer screening programmes customized to their health systems, reducing the impact of lung cancer on their people. This opportunity builds on decades of implementation research.
