Cassandra’s tears: population lung cancer screening in Western Europe

There is currently a highly unusual disparity in international access to lung cancer screening. Typically, underserved people in nations with restricted resources experience lower access to medical care and poorer outcomes than those in more prosperous societies. Today, the converse is true in Western Europe, where public access to lung cancer screening is unavailable outside of a research study. A review of global lung cancer screening public policy shows that, while population screening is now widely practiced in Asia and the United States, only three nations in Central Europe today offer national lung cancer screening programs, i.e., Poland (2020), Croatia (2020) and Czechia (2022). In Western Europe, despite major public expenditure to complete multiple randomized control trials (which reported highly favorable results), there is still today no nation that offers full access to a national CT screening program for citizens at risk. Why have Western European public health officials been reluctant to act in a timely manner while their citizens suffer and die—unscreened—from lung cancer? This question has major medical, social, ethical and political implications. The pathway from initial concept through research, guideline development, public health policy and funding is highly complex and differs substantially in individual nations. Policy research to determine the reasons for protracted delay in the implementation of population CT lung cancer screening in Western Europe is urgently needed. Every day of future delay in implementation will inevitably result in more unnecessary suffering and preventable death.