Development and Implementation of an Integrated Early Lung Cancer Detection Program in Ethiopia: A Scalable Framework for Resource-Constrained Settings

In low- and middle-income countries(LMICs), barriers to early lung cancer(LC) detection extend beyond CT scanner availability to encompass participant identification pathways, digital management infrastructure, multidisciplinary coordination, and workforce capacity. Ethiopia's high tuberculosis burden, widespread biomass fuel exposure, and centralized oncology services create a distinct implementation environment. This report describes implementation and operational lessons from the first integrated LDCT-based early LC detection program in Ethiopia.

An integrated program was implemented at two tertiary referral centers in Addis Ababa between March 2024 and May 2026 using a phased strategy that deliberately prioritized infrastructure development before large-scale recruitment. Core components included an Ethiopian Thoracic Society-adapted ten-domain risk assessment framework incorporating locally relevant exposures, the ScreeningPLUS digital management platform, AI-assisted nodule detection, multidisciplinary review, smoking cessation counseling, and integration of tuberculosis and pulmonary medicine referral pathways into a unified detection infrastructure.

A comprehensive early LC detection infrastructure was successfully established within existing healthcare systems. Key implementation challenges include equipment importation delays exceeding six months, digital infrastructure adaptation, variable patient identification practices, and multi-service workflow integration. The multi-pathway design proved essential: 73.9% of participants had never smoked, confirming that tobacco-based eligibility criteria alone would have excluded the majority of the target population. Following infrastructure maturation and focused outreach,enrollment increased substantially, supporting a phased approach in which operational readiness precedes large-scale recruitment.

Integrated early LC detection is achievable in resource-constrained settings when approached as a systems-level effort emphasizing phased infrastructure development, local adaptation, and pathway integration. These lessons provide a practical framework for LMIC implementation.