Community-based low-dose computed tomography lung cancer screening program in Vietnam: evidence for national policy

Low-dose computed tomography (LDCT) screening reduces lung cancer mortality in high-risk individuals, yet integrated program-level evidence spanning diagnostic, operational, economic, and behavioral outcomes from Southeast Asian low- and middle-income countries remains scarce. We evaluated a prospective, two-round, community-based LDCT screening program in Vietnam.

Adults aged 50-74 years with ≥ 20 pack-year smoking histories were recruited through 30 commune health stations in two Hanoi districts for baseline (round 1) and annual repeat (round 2) LDCT at the Vietnam National Cancer Hospital (January 2024-February 2026), under a semi-centralized model. Two independent thoracic radiologists interpreted examinations using Lung-RADS version 2022. Prespecified outcomes were diagnostic performance, inter-round Lung-RADS trajectories, participation and adherence, cost metrics with willingness-to-pay, and self-reported smoking behavior.

Of 3,288 eligible invitees, 2,100 (63.9 %) completed round 1 and 1,288 of 1,919 (67.1 %) completed round 2. Detection rates were 0.57 % (12 cases) and 0.16 % (2 cases) at rounds 1 and 2; adenocarcinoma accounted for 11 of 14 confirmed cases (78.6 %), and the early-stage (TNM I-II) fraction rose from 33.3 % to 50.0 %. Inter-round binary Lung-RADS agreement was 87.7 %. Cost per confirmed lung cancer was USD 5,300, satisfaction 96.6 %, and median willingness-to-pay (USD 24) matched the LDCT unit cost. Self-reported former smokers rose from 2.6 % to 19.1 % (P < 0.001).

A semi-centralized, community-based LDCT program in Vietnam achieved diagnostic yield comparable with leading Asian programs, high participation, an acceptable per-cancer cost, and measurable cessation benefits. These findings provide an empirical foundation for designing a national lung cancer screening program in Vietnam.