He's a professor at the Medical University of Ghent. Dr. Rysman was one of the primary organizers of the Pilot National Lung Cancer Screening Implementation Program in Poland. And he's the leader of several grants and projects on lung cancer screening. He's going to share Eastern and Nordic Europe's experience implementing CT lung cancer screening. Thank you for the introduction. Good morning, everyone. I will present the summary on status of lung cancer screening implementation in Central and the Nordic Europe. We are talking here about the area with about 180 million inhabitants. This is about 40% of European population, excluding Russia. 27 in Nordic countries, 27 million, of course, and 150 in Central Europe. All the information I gathered through my personal contacts and, of course, through literature and web search. The first slide is not very optimistic, because in nine of 18 countries, there is no pilot program, no other lung cancer screening program. Neither the implementation date has been decided yet. And this is one third of the population we are talking about. But now we're going to the more optimistic slide. Croatia was the first country in Europe that implemented lung cancer screening nationwide implementation. That was 2020. And between 2020 and 2023, they performed more than 25,000. I mean, they recruited more than 25,000 individuals. They performed nearly 32,000 CT scans. This is the stage distribution, which shows a pretty high proportion of stage four. But as was mentioned before, this is probably characteristic for the real world program. So Poland is the next one that is going to implement lung cancer screening. We completed our pilot study in 2023. And we have after that six high quality screening centers. And the idea of this program was to allow low-dose CT to be performed in all radiological department that meets quality criteria, technology criteria. But the low-dose CT reading should be performed in these high quality centers. In the future, any entirety can apply to become a high quality center after obtaining appropriate accreditation. This is the results of our pilot study, 20,000 volunteers almost, 37,000 CT scans performed. The lung cancer detection rate was 1.8%. The surgery performed in 66% of all individuals with lung cancer. And the mean adherence in six regions of Poland was 66%. But it varied widely, because it was between 10% and 95%. So this is something to do in this area. Now we are struggling to shape the program that is planned to be implemented from 1st January 2025, so in four months. And this is the date of implementation. Maybe it will be a little bit later. I mean, a little bit, not more than half year. Czech Republic next, they performed a feasibility study between 2022 and 2023 that was addressed to nearly the same population as in all central European countries, so 55 to 74 years of age, more than 20 PAGEAs. And 23% of all GPs and 70% of pneumonologists in Czechia were involved in this pilot program. They sent invitations to more than 10,000 individuals. And 50% of them responded positively. So they performed more than 5,000 CTs. Lung cancer detection rate was 1%. Stage 1 detected in 51% of all individuals. And implementation date is set to 2027. In Hungary, the three-step pilot was decided. They performed, at the beginning, Hanchest 1, then Hanchest 2, and ongoing Hanchest 3 project. In the first one, they tested the screening protocol. In the second one, a screening pathway. And now, this is the modeling study before implementation. But the implementation date has not been decided yet. Serbia, in Serbia, they performed a regional program in Vojvodina County. And they estimated that the population at risk was 33,000 individuals in this area. But finally, only 1,100 was screened. So pretty low recruitment. Lung cancer detection rate was 1.5%. And stage 1 to 3A detected in 65% of individuals. And the implementation date is promised, not decided, but promised by government to 2030. Denmark, we're going north. Denmark, we all remember one of the first randomized control trials in Denmark, Danish trial. But since then, nothing really happened in Denmark until 2023, when Rene Pettersen, my good friend who is sitting here, gave an interview about mini-invasive surgery in lung cancer, in early stage lung cancer. And that pushed lung cancer screening forward very quickly in Denmark. So shortly, in May 2023, the Ministry of Health in Denmark dedicated 30 million Danish crowns for the pilot study. Pilot study has already started. They plan to finish it in 2026, then perform the major analysis. And they set the date of implementation to 2026, the end of 2026, or the beginning of 2027. Sweden, they have four pilots before implementation. The first pilot was addressed only to women in Stockholm. It has been completed. Two other pilots has started in the other districts of Sweden. And they plan also the pilot study for men. Implementation date was not decided. No way. They are part of the four-in-the-run study, pretty small study, but with very high lung cancer detection rate of 3%. What is very characteristic for all Scandinavian countries, actually, this is inclusion criteria. If you look at it, it is 60 to 70 years of age. This is more than 35 pack years of smoking. And PLCO 2012 risk model with threshold more than 2.6%. They sent in Norway more than 100,000 invitations, and 10% of all invited individuals accepted it. And finally, Estonia. In Estonia, they performed very small feasibility study to investigate actually the bottlenecks of systematic enrollment by family practitioners. And the study was really small with three practices, but very high uptake. 87% of invited individuals accepted this invitation. So this is really a good result, and we can learn from them a lot. They also run another program for a much higher number of the district doctors that were involved. And I get information that the uptake was also very high, 79%. So the final conclusion is that of 18 countries in the region I was talking about, in four, the date has already been set, date of nationwide implementation. In two, the date is promised. And in 12, has not been decided yet. But I personally think that when we implement the lung cancer screening in the neighboring countries, that will accelerate the lung cancer screening process also in the remaining 12. Thank you.

lung cancer screening

Eastern Europe

Nordic Europe

implementation status

Dr. Rysman