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2 October 2024
We detail the status of lung cancer screening across the Central and Eastern European focusing on Croatia, Poland, Hungary and Czechia – this builds off the Network’s roundtable discussion Accelerating action: lessons from lung cancer screening in Central and Eastern Europe.
Early adopters of screening in Europe
In 2020, Croatia became the first country in the European Union to establish a national lung cancer screening programme. Since then, three countries in the region have followed, and are at various stages of implementation. Screening for lung cancer has become more prominent at the European level due to the European Council’s recommendation to include lung cancer screening, and the EU4Health project ‘Strengthening the screening of Lung Cancer in Europe’ (SOLACE), which aims to facilitate implementation. Many CEE countries are part of SOLACE, and can therefore access EU funds for screening.
Within CEE, many countries have a well-established screening infrastructure, partly due to former high rates of tuberculosis (TB). This existing infrastructure, as well as centralised health systems, place the region in a strong position to implement new screening programmes.
Screening programmes are helping detect lung cancer earlier
Some countries in the CEE region have the highest lung cancer incidence and mortality rates in in Europe.1 Over 80,000 people there are diagnosed every year, and this is increasing annually – particularly among women.1 2 High smoking rates – potentially due to limited tobacco-control measures – are a major contributing factor to the high rates of lung cancer.3
Earlier detection, achieved through screening, aims to address the late diagnosis of lung cancer in the region and improve outcomes; currently, 50% of lung cancer is diagnosed at a late stage, when the five-year survival rate is less than 10%.4 5
Snapshot of screening activity
Croatia
The aims of the national screening programme, which was established in 2020, are to achieve a screening coverage of 50% of the target population by 2025, and to reduce 20% of lung cancer deaths by 2030. You can find more information here.
The programme has surpassed its first aim, achieving a screening coverage of over 80% by 2023. More than 30,000 scans had been conducted by the end of 2023, screening over 26,000 participants and identifying over 300 cancers, including lung cancers. The programme’s success has positioned it as a model for other countries to emulate.
What is next?
Going forward, Croatia intends to optimise the programme even further. Data on its cost effectiveness are being collected to help with this.
Poland
In Poland, a National Pilot Lung Cancer Screening Programme funded by the European Social Fund ran from 2020 until 2023; initially, it was severely hampered by the COVID-19 pandemic. Over the three-year period, the pilot aimed to enrol more than 19,000 participants aged 50–74 across six macro-regions, with six research centres leading the implementation. Find out more about the programme here.
During the pilot, almost 40,000 CT scans were performed on over 19,000 screening participants.6 The programme has improved early detection rates, with up to 70% of people diagnosed at stage 1.
What is next?
Data from the programme are being analysed. Preliminary findings, which show that lung cancer was detected in 1.7% of participants, have helped create momentum for implementing a national screening programme covered by the national health insurer.6
Hungary
Hungary has had three pilot screening programmes over the past decade:
- The first pilot (2013–20) aimed to demonstrate the feasibility of lung cancer screening in the country
- The second (2019–22) aimed to establish a patient pathway
- The third (which began in 2023 and is ongoing) aims to determine the efficacy of identifying those at highest risk of lung cancer and inviting them to an LDCT screening.
The first pilot involved nearly 2,000 participants aged 50–79 and had a 1.5% lung cancer detection rate. It showed that LDCT screening was feasible, and the protocol and reporting platform were deemed effective.
The second pilot involved over 4,000 participants aged 50–75 and had a 1.8% lung cancer detection rate. Approximately 60% of cases were diagnosed at stage 1; this was an increase of more than 50% in stage 1 diagnoses compared to those in the control group, who were not screened. There was also a decrease of over 30% in stage 4 diagnoses.
What is next?
Preliminary data from the third pilot are expected in 2025.
Czechia
In 2022, a five-year population pilot screening programme was launched. It targets former or current smokers aged 55–74 with a smoking history of at least 20 pack-years.
The programme has helped improve early detection rates – nearly 60% of people are being diagnosed at stage 1 or 2, compared to only 15% before the programme. In the first 27 months, more than 29,400 people were reached, and over 9,600 have had their first LDCT scan.7 Find out more information here.8
What is next?
It is hoped that, as the pilot continues, current challenges – such as, geographic disparities in screening coverage, delayed referrals and seasonal variations in screening uptake – can be addressed to ensure its long-term success. This can inform a recommendation for the appropriate programme design to be implemented in the health system.
Conclusion
The screening success seen across the CEE region provides further evidence of the opportunity that lung cancer screening offers in terms of increasing early detection, and reducing mortality. This real-world evidence adds weight to the call for accelerated implementation of screening for lung cancer across Europe.
European countries and similar health systems can learn from the CEE region when building their own pilots and programmes. And, countries in Europe can also take advantage of EU initiatives, such as the SOLACE project, to help with planning and setting up lung cancer screening programmes.
The Lung Cancer Policy Network is publishing brief case studies of countries that have implemented LDCT screening; you can read other examples here.
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References
International Agency for Research on Cancer. 2022. Cancer today. Available from: https://gco.iarc.fr/today/en/dataviz/bars?mode=population [Accessed 03/04/24]
International Agency for Research against Cancer. Cancer Tomorrow. Available from: https://gco.iarc.fr/tomorrow/en/dataviz/bars [Accessed 03/04/2024]
Vrdoljak E, Bodoky G, Jassem J, et al. 2016. Cancer Control in Central and Eastern Europe: Current Situation and Recommendations for Improvement. Oncologist 21(10): 1183-90
Sheikh M, Virani S, Robbins HA, et al. 2023. Survival and prognostic factors of early-stage non-small cell lung cancer in Central and Eastern Europe: A prospective cohort study. Cancer Med 12(9): 10563-74
Polanco D, Pinilla L, Gracia-Lavedan E, et al. 2021. Prognostic value of symptoms at lung cancer diagnosis: a three-year observational study. J Thorac Dis 13(3): 1485-94
Adamek M. 2024. Personal communication by email: 22/09/24
Koblížek V. 2014. Personal communication by email: 19/09/24
Májek O, Koziar Vašáková M, Čierna Peterová I, et al. PrevenceProPlice.cz – Early Detection Programme for Lung Cancer [online]. Available from: https://www.prevenceproplice.cz/en/ [Accessed 19/09/24]