Lung cancer is the fourth most frequently diagnosed cancer in the European Union. Risk factors for lung cancer include smoking in particular, but also family history, idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease (COPD), and occupational or environmental exposure to radon, asbestos or fine particles. Different imaging technologies such as chest X-ray and (low-dose) computed tomography (LDCT or CT) can be used for lung cancer screening. While breath and blood biomarkers are still at an early stage of development, screening with LDCT is increasingly offered in routine clinical practice. There is currently no agreed policy for lung cancer screening in Europe.

The aim of the EUnetHTA assessment was to provide a reliable synthesis and analysis of the available evidence on lung cancer screening in risk groups. Based on the evidence from 8 randomised controlled trials (RCTs), it was shown that screening for lung cancer with LDCT in (former) heavy smokers probably reduces lung cancer mortality (high quality evidence), but results in little or no difference in overall mortality (moderate quality evidence), compared with no screening. LDCT screening probably saves approximately 5 out of 1000 individuals (95% CI 3–8) from dying of lung cancer within approximately 10 years and may potentially extend the life of some of these screening participants compared to no screening. The benefit in terms of mortality is mainly opposed by the harm resulting from false-positive screening results and overdiagnosis. For risk groups other than (former) heavy smokers, no studies investigating lung cancer screening using LDCT compared to no screening could be identified. Insufficient evidence is available to answer the research question, whether one specific strategy in lung cancer screening is favourable compared to other screening strategies or wether to use another screening interval than 1 year. Furthermore, no evidence from RCTs is currently available for the use of biomarkers as an adjunct to LDCT in lung cancer screening. 15 studies (5 RCTs, 3 observational studies, 7 uncontrolled pre-post intervention studies) were included from the systematic literature search to evaluate the best strategy on how to inform individuals in the target group about a lung cancer screening programme in order to optimise informed choices regarding participation. Overall, the current evidence is not sufficient to assess the effectiveness of a particular information or invitation strategy for lung cancer screening. Moderate to low quality of evidence shows that the use of decision aids prior to LDCT scan (compared to standard information materials) in the context of a lung cancer screening programme probably increases a) the knowledge about benefits and harms of lung cancer screening, b) informed decision-making and c) the participant empowerment regarding a decision on lung cancer screening participation.