Croatia’s lung cancer screening program is the first national lung cancer screening program in the EU to be incorporated into an existing healthcare infrastructure, according to an article published on 6 December in European Radiology.
The scheme was designed to be multidisciplinary and accessible, and a central role is played by general practitioners (GPs) who identify and refer high-risk patients in a central role, noted a group of authors headed by Prof. Miroslav Samaržija, a pulmonologist and coordinator of the National Lung Cancer Screening Programme (NLCSP), University of Zagreb.
Graphical abstract of the NLCSP.Samaržija et al; European Radiology
The NLCSP was developed through a multidisciplinary Lung Cancer Screening Working Group established by Croatia’s Ministry of Health. Croatia has one of the highest mortality-to-incidence ratios for lung cancer in the EU, in large part due to diagnosis at advanced stages, the authors write, along with the still-high prevalence of smoking in Croatia.
The program was designed for nationwide deployment to ensure equitable access for all at-risk patients. It incorporates several other significant innovations in its design, such as the inclusion of smoking cessation, complete digitization, the application of the International Early Lung Cancer Action Program (I-ELCAP) criteria for nodule management in modified form, and volumetric analysis assessed by AI. The role of GPs in identifying and referring high-risk patients is a central aspect of the program, Samaržija’s team notes.
Prioritizing the GP’s role is critical to the accessibility of the NLCSP, and was aimed at combating the low rate of enrollment of eligible patients that is sometimes found in other countries’ lung cancer screening programs.
All Croatians have a dedicated GP, with approximately 90% of the population visiting their GP annually. There is a network of approximately 2,300 GP clinics throughout the country, each serving about 1,800 patients. Thus, GPs can conduct annual interviews for most patients to determine eligibility for the NLCSP and enroll them in the program if they are candidates; enrollment includes smoking-cessation counseling and a discussion of potential risks and benefits of screening. Screening candidates then make an appointment for low-dose CT (LDCT) scanning at any of the 24 radiology sites across the country (based on location and appointment availability).
A custom IT application was developed and integrated into the existing national IT healthcare platform with the aim of providing a secure, centralized, paperless system. This application was designed for radiology and pulmonology referrals, structured reporting, and report sharing, in order to enable collaboration between different providers and reduce delays in diagnosis and treatment. The NLCSP software uses a unique identifier for each screening participant, which also functions as a personal identifier for all other healthcare procedures; the data is stored in the patient’s digital personal healthcare record, the authors add.
Between October 2020 and August 2025, the Croatian NLCSP has resulted in the screening of more than 50,000 participants, with more than 70,000 LDCT scans performed. The screened cohort comprises 54% male and 46% female participants, with an average age of 62. Of those screened, 4.5% had positive results; 2% were determined to have cancer (1.7%, lung cancer).
“No European Union country has implemented a national lung cancer screening program despite evidence from previous trials showing significant mortality reduction,” the authors state. They noted that the Croatian program, which is integrated into the national healthcare infrastructure, is fully reimbursed and designed for equitable access. It could serve as a replicable template for other such national screening programs, they added.
Read the European Radiology article here.
