From aspiration to reality: a cross-country analysis of the implementation of lung cancer screening in Europe

Background: Implementation of lung cancer screening (LCS) has been slow across geographical Europe. Only three countries have a formal LCS program: Croatia, Poland, and England. Objective: This study aims to review the status of LCS and identify the barriers to implementation of formal programs. Methods: A framework to assess the status and identify key gaps was used, consisting of five dimensions: (1) policy prioritization and governance, (2) clinical review, (3) program design, (4) implementation, and (5) awareness. The research was conducted in 10 countries including Belgium, Croatia, England, France, Germany, Greece, Italy, Poland, Spain, and Sweden. Across countries, the assessment framework was applied to identify key barriers. The assessment was validated with local experts. Results: Countries are at different stages of implementation, with large variability in the proposed program design. The cross-country analysis found common barriers. A crucial driver of stimulating political commitment is a local network of well-connected clinicians and patients. Although governments request local data to support decision making, in many countries, local data collection is minimal or stalled. Implementation is the most underdeveloped dimension in the framework, commitment to sufficient funding and infrastructure for scaling up pilots and post screening care delivery is a common barrier. Finally, awareness amongst the public and healthcare professionals requires improvement. Conclusion: Progress depends on a number of factors namely, political will, funding commitment, a local network of well-connected experts, availability of local evidence, and feasibility assessments.