Beyond the Scan: Adapting Multimodal Lung Cancer Screening for Central and Eastern Europe-Overcoming Systemic...

Area of Science:

• Oncology
• Public Health
• Radiology

Background:

• Lung cancer is a leading cause of mortality in Central and Eastern Europe (CEE).
• Late-stage diagnosis and healthcare limitations hinder early detection in the region.
• Regional epidemiological factors further complicate lung cancer screening efforts.

Purpose of the Study:

• To synthesize evidence on lung cancer epidemiology and screening in Romania, Poland, Hungary, and Bulgaria.
• To propose a context-adapted multimodal screening strategy for CEE settings.
• To identify barriers and facilitators for lung cancer screening implementation in the region.

Main Methods:

• A structured literature review of PubMed, Scopus, and Web of Science databases (2010-2025).
• Focus on lung cancer epidemiology, screening, implementation barriers, risk stratification, and diagnostic approaches in four CEE countries.
• Inclusion of 297 relevant articles.

Main Results:

• High burden of late-stage lung cancer persists in CEE due to tobacco, pollution, radon, comorbidities, and diagnostic delays.
• Tuberculosis and chronic lung disease complicate nodule interpretation, reducing screening specificity.
• Low-dose computed tomography (LDCT) with volumetric assessment shows feasibility in Poland and Hungary; risk prediction and biological triage show potential but require validation.

Conclusions:

• A multimodal, context-adapted lung cancer screening program is recommended for CEE.
• Key components include risk-based enrollment, volumetric LDCT, selective biological triage, smoking cessation support, and centralized multidisciplinary delivery.
• Addressing regional inequalities and healthcare limitations is crucial for successful implementation.