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

Objectives: 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. Materials and methods: 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. Results: 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. Conclusion: 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. Key Points: 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.