Design of the first national lung cancer screening program in the European Union: the Croatian Model.

Abstract

To address Croatia's high lung cancer mortality and late-stage diagnoses, the Ministry of Health initiated a multidisciplinary effort to design a national lung cancer screening program. Lung cancer remains one of the leading causes of cancer-related mortality both globally and in Croatia. In 2021 alone, Croatia recorded over 3300 new cases of lung cancer and more than 2800 associated deaths, indicating a high mortality burden. In response to this public health concern, the Ministry of Health has established a multidisciplinary Lung Cancer Screening Working Group, tasked with developing a national screening approach. The Program incorporates several innovative elements, including the application of modified International Early Lung Cancer Action Program (I-ELCAP) criteria for nodule management, volumetric analysis assessed by artificial intelligence, complete digitalization, smoking cessation, and nationwide deployment to ensure equitable access. From October 2020 to August 2025, over 50,000 participants were screened, resulting in more than 70,000 LDCT scans performed. The cohort includes 54% male and 46% female participants, with an average age of 62 years. Among these participants, 4.5% had positive results, which required further follow-up. The Croatian National Lung Cancer Screening Program offers unique features as it has been comprehensively incorporated into the existing healthcare infrastructure and is fully reimbursed. A key aspect of the program is the important role assigned to general practitioners (GPs), who are responsible for identifying and referring individuals at high risk for lung cancer. Question No European Union country has implemented a national lung cancer screening program despite evidence from previous trials showing significant mortality reduction. Findings Croatia successfully launched a fully integrated national lung cancer screening program using LDCT, AI-assisted volumetric analysis, modified I-ELCAP criteria, and GP-centered recruitment. Clinical relevance The Croatian model demonstrates the feasibility of national lung cancer screening within a European public healthcare system with full reimbursement, providing a replicable framework for other EU countries implementing lung cancer screening programs.