Design of the first national lung cancer screening program in the European Union: the Croatian Model.
Summary
Croatia implemented the EU’s first fully integrated, reimbursed national lung cancer screening program with LDCT, AI-assisted volumetrics, modified I-ELCAP criteria, and GP-centered recruitment. Over 50,000 participants were screened with a 4.5% positive rate, demonstrating feasibility, scalability, and equity within a public healthcare system.
Key Findings
- Nationwide LDCT screening implemented with AI-assisted volumetric analysis and modified I-ELCAP criteria.
- Over 50,000 participants and >70,000 LDCT scans between Oct 2020 and Aug 2025.
- Positive result rate of 4.5%, with full reimbursement and system-wide digital integration.
- General practitioners played a central role in identifying and referring high-risk individuals.
Clinical Implications
Health systems can model GP-centered referral, AI volumetrics, and digital pathways to scale equitable LDCT screening; linked smoking cessation is essential to maximize population benefit.
Why It Matters
This is a real-world template for scaling LDCT lung cancer screening across EU systems, integrating AI and primary care, with potential to reduce mortality and standardize workflows.
Limitations
- Observational implementation report without randomized comparison or mortality outcome data yet.
- Positive rate reported; downstream diagnostic yield, stage shift, and cost-effectiveness analyses are pending.
Future Directions
Report stage distribution, interval cancers, mortality reduction, and cost-effectiveness; validate AI volumetrics across vendors; share interoperable workflows for EU replication.
Study Information
- Study Type
- Cohort
- Research Domain
- Prevention
- Evidence Level
- II - Large-scale programmatic cohort implementation with standardized protocols.
- Study Design
- OTHER