Background & Objectives: The European Commission has proposed to extend organized cancer screening to additional sites, including lung, prostate, and gastric cancer; however, evidence on the effectiveness and population-level impact of these screening programmes remains inconclusive and is under active investigation. The aim of our study is to describe the population-level burden of lung cancer in Slovenia to assess the potential impact of introducing an organized lung cancer screening programme. Specifically, we aimed to quantify current and projected lung cancer incidence, identify population groups at increased risk and evaluate the potential contribution of screening to reducing the lung cancer burden.
Methods: Population-based lung cancer incidence data from population-based Slovenian Cancer Registry (available since 1961) and gender-stratified smoking data (available since the 1970s) were analysed. Age–period–cohort generalized linear models were used to estimate the relative effects of age, calendar period, and birth cohort on lung cancer incidence. Future incidence was forecasted using generalized additive models with penalized cubic splines and restricted maximum likelihood estimation, incorporating smoking prevalence and intensity as a covariate. Lung cancer mortality burden was quantified using years of life lost (YLL) estimates. The expected effects of screening were estimated by modelling the anticipated stage shift and assessing the associated changes in YLL and frequency of surgical treatment.
Results: Among current and former smokers aged 50–74 years, an average of 360 asymptomatic individuals must be screened to detect one case of lung cancer. As a gradual decline in lung cancer incidence is expected in younger age groups in the future, the screening target population will need to be re-evaluated over time. Based on the current situation, the most favourable balance between screening effort and population benefit is expected in the 60–69-year age group. Evidence is clear that, if a screening programme is introduced, both male and female current and former smokers should be included. Assuming a 70% participation rate among smokers, the proportion of lung cancer diagnosed at a localized stage would increase by 19 percentage points at the population level. However, with a more realistic 35% participation rate, the increase would be limited to 9.5 percentage points. Higher participation–associated stage shift would result in a 16% reduction in YLL and an almost twofold increase in surgical procedures; however, with a participation rate of 35% among smokers, YLL would decrease by only 8%, and surgical volume would increase by approximately one quarter.
Conclusions/Implications: Currently, the conditions for implementing an organized lung cancer screening programme in Slovenia are not fully met. Despite the significant public health burden of lung cancer, the target population and screening methodology remain insufficiently defined. With appropriate policy support, Slovenia could participate in pilot studies to assess feasibility and uptake. A pilot study should include current and former smokers aged 50–74 years, where most benefits are expected in the age group 60-69 years.