By Matthew Watson

Despite declining tobacco use, lung cancer remains the leading cause of cancer deaths globally, often evading detection until advanced stages. It is unsurprising, then, that interest in targeted lung screening (LCS) programmes has risen markedly in recent decades. Landmark clinical studies, including the NLST and NELSON trials, have done much to progress international discussions among leading health authorities, establishing lung screening’s potential to improve patient outcomes. A major development this year, however, was the EU’s official recommendation for lung screening programmes at national and regional levels across its 27 members. Now, many member states are entering the implementation phase of their respective programmes.

Computed Tomography (CT) is the dominant and recommended modality for lung cancer screening. Therefore, the policy shift will engender heightened demand for CT equipment over the next decade and beyond. Yet fundamental questions about the scale, approach, and pace of LCS implementation must still be answered, all factors determining how CT vendors can capitalise on the growing market opportunity.

Delivering large-scale screening programmes can be time-consuming and often onerous. Few notable examples of national LCS programmes exist worldwide, beyond China, South Korea, and the U.S. In the U.S., the CDC estimates that only around 6% of the eligible population ever undergo the procedure. This underutilisation stems from several significant barriers to uptake, including poor reimbursement opportunities for private clinics, insurers’ restricting policy coverage to lower-cost imaging centres, and underinvestment in geographic reach. Although the market presence of mobile imaging centres is expanding, this change has been gradual. Whether European programmes will fare better in these respects remains to be seen. Still, more densely populated nations with substantial public funding have had a more successful track record of implementing other screening programmes, such as those for breast cancer.

Additionally, regardless of how competently designed and executed lung cancer screening programmes are, the speed of implementation so far indicates that the near-term market impact of new and revised LCS initiatives will be relatively modest. France, for instance, has scheduled its CASCADE pilot for 2024 at the earliest. As mentioned, participation in the U.S. is still constrained by limited funding, and in the U.K., the NHS has been running a pilot in parts of England since 2019, but no roadmap for the national rollout has yet been announced. Instead, LCS-driven CT demand will materialise mainly in the medium to long term, with the help of emerging clinical findings and international collaboration efforts, such as the SOLACE project in the EU.

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