Epidemiology and Prevention of Lung Cancer in Europe: A review of Burden, Disparities, and the Path to Equitable Early Detection
DOI:
https://doi.org/10.5644/ama2006-124.511Keywords:
Lung cancer, Epidemiology, Prevention, Tobacco control, Southeastern EuropeAbstract
This review synthesizes current evidence on the global epidemiology and prevention of lung cancer, with a focused analysis of the Southeastern Europe region. Lung cancer remains the leading cause of cancer-related mortality worldwide, reflecting persistent exposure to modifiable risk factors and substantial inequities in early detection and treatment access. Data from GLOBOCAN, the Global Burden of Disease study, randomized controlled trials, and population-based registries were used to assess trends in incidence, mortality, and survival, and to examine the evolving distribution of histological subtypes and molecular profiles. While tobacco smoking remains the leading risk factor, a growing proportion of lung cancer, especially among never-smokers, is attributable to non-tobacco exposures, including ambient and household air pollution, occupational carcinogens, and residential radon. Despite advances in targeted therapies and immunotherapy, overall survival remains poor, largely due to late-stage diagnosis. Evidence from landmark trials demonstrates that low-dose computed tomography (LDCT) screening reduces lung cancer mortality primarily through stage migration, enabling detection at earlier, more treatable stages. Southeastern Europe continues to experience a high burden driven by tobacco exposure, limited screening implementation, and restricted access to molecular diagnostics. Inequities in screening eligibility, uptake, and access to advanced therapies worsen survival outcomes across socioeconomic and demographic groups.
Conclusions. Effective lung cancer control requires a multi-level prevention strategy integrating strengthened tobacco control policies, risk-stratified LDCT screening, and equitable access to molecular testing and treatment. Future research priorities include understanding lung cancer in never-smokers, evaluating long-term risks of emerging exposures such as e-cigarettes, and utilizing multi-omics approaches to refine risk stratification and guide targeted therapy.
References
Global Burden of Disease Study 2023 (GBD 2023) Results. [Internet]. 2024 [cited March 2025]. Available from: https://vizhub.healthdata.org/gbd-results/.
Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-63. doi:10.3322/caac.21834.
Zhu H, Di Carlo V, Khan Baloch F, Allemani C, Coleman on behalf of the Concord Working Group MP. P4. 17D. 02 Global Trends in Lung Cancer Survival by Morphology: Analysis from 61 Countries During 2000-
2014 (CONCORD-3). Journal of Thoracic Oncology. 2024;19(10):S420. doi:10.1016/j.jtho.2024.09.766.
Allemani C, Matsuda T, Di Carlo V, Harewood R, Matz M, Niksic M, et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet. 2018;391(10125):1023-75. doi:10.1016/S0140-6736(17)33326-3.
Lemjabbar-Alaoui H, Hassan OU, Yang YW, Buchanan P. Lung cancer: Biology and treatment options. Biochim Biophys Acta. 2015;1856(2):189-210. doi:10.1016/j.bbcan.2015.08.002.
Ning J, Ge T, Jiang M, Jia K, Wang L, Li W, et al. Early diagnosis of lung cancer: which is the optimal choice? Aging (Albany NY). 2021;13(4):6214-27. doi:10.18632/aging.202504.
Dela Cruz CS, Tanoue LT, Matthay RA. Lung cancer: epidemiology, etiology, and prevention. Clin Chest Med. 2011;32(4):605-44. doi:10.1016/j.ccm.2011.09.001.
Perez-Moreno P, Brambilla E, Thomas R, Soria JC. Squamous cell carcinoma of the lung: molecular subtypes and therapeutic opportunities. Clin Cancer Res. 2012;18(9):2443-51. doi:10.1158/1078-0432.CCR-11-2370.
Rey Brandariz J, Rumgay H, Ayo-Yusuf O, Edwards R, Islami F, Liu S, et al. Estimated impact of a tobacco-elimination strategy on lung-cancer mortality in 185 countries: a population-based birth-cohort simulation study. Lancet Public Health. 2024;9(10):e745-e54. doi:10.1016/S2468-2667(24)00185-3.
Meyer ML, Peters S, Janne PA, Mok TS, Bunn PA, Abdel Karim N, et al. Global advances and future directions in lung cancer care: expert consensus and strategic priorities. ESMO Open. 2026;11(2):106034. doi:10.1016/j.esmoop.2025.106034.
Jemal A, Miller KD, Ma J, Siegel RL, Fedewa SA, Islami F, et al. Higher Lung Cancer Incidence in Young Women Than Young Men in the United States. N Engl J Med. 2018;378(21):1999-2009. doi:10.1056/NEJMoa1715907.
Lortet-Tieulent J, Soerjomataram I, Ferlay J, Rutherford M, Weiderpass E, Bray F. International trends in lung cancer incidence by histological subtype: adenocarcinoma stabilizing in men but still increasing in women. Lung Cancer. 2014;84(1):13-22. doi:10.1016/j.lungcan.2014.01.009.
Lyratzopoulos G, Abel GA, Brown CH, Rous BA, Vernon SA, Roland M, et al. Socio-demographic inequalities in stage of cancer diagnosis: evidence from patients with female breast, lung, colon, rectal, prostate, renal, bladder, melanoma, ovarian and endometrial cancer. Annals of oncology. 2013;24(3):843-50. doi:10.1093/annonc/mds526.
Zhang J, Tang J, Yang R, Chen S, Jian H, Zeng P. The global, regional, and national burden of tracheal, bronchus, and lung cancer caused by smoking: an analysis based on the Global Burden of Disease Study 2021. Annals of global health. 2024;90(1):77. doi:10.5334/aogh.4572.
Sheikh M, Virani S, Robbins HA, Foretova L, Holcatova I, Janout V, et al. Survival and prognostic factors of earlystage non‐small cell lung cancer in Central and Eastern Europe: a prospective cohort study. Cancer Medicine. 2023;12(9):10563-74. doi:10.1002/cam4.5791.
World Health Organization. Two decades of the implementation of the WHO Framework Convention on Tobacco Control in the European Union: progress, challenges and the road ahead. Copenhagen: WHO
Regional Office for Europe; 2025. Report No.: WHO/EURO:2025-12743-52517-81148.
Teixidor-Vila E, Trallero J, Puigdemont M, Vidal-Vila A, Hernandez-Martinez A, Sais E, et al. Lung cancer survival trends and prognostic factors: A 26-year populationbased study in Girona Province, Spain. Lung Cancer. 2024;197:107995. doi:10.1016/j.lungcan.2024.107995.
de Koning HJ, van der Aalst CM, de Jong PA, Scholten ET, Nackaerts K, Heuvelmans MA, et al. Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial. N Engl J Med. 2020;382(6):503-13.
doi:10.1056/NEJMoa1911793.
Tang FH, Wong HYT, Tsang PSW, Yau M, Tam SY, Law L, et al. Recent advancements in lung cancer research: a narrative review. Translational Lung Cancer Research. 2025;14(3):975-90. doi:10.21037/tlcr-24-979.
Francisci S, Minicozzi P, Pierannunzio D, Ardanaz E, Eberle A, Grimsrud TK, et al. Survival patterns in lung and pleural cancer in Europe 1999-2007: Results from the EUROCARE-5 study. Eur J Cancer. 2015;51(15):2242-53. doi:10.1016/j.ejca.2015.07.033.
De Angelis R, Sant M, Coleman MP, Francisci S, Baili P, Pierannunzio D, et al. Cancer survival in Europe 1999–2007 by country and age: results of EUROCARE-5—a population-based study. The lancet oncology.
2014;15(1):23-34. doi:10.1016/S1470-2045(13)70546-1.
Shong LY-W, Lam DC-L. Emerging Trends in Global Lung Cancer Burden. Seminars in respiratory and critical care medicine. 2025;46(5):409-18. doi:10.1055/a-2651-0612.
Martinez R, Soliz P, Caixeta R, Ordunez P. Reflection on modern methods: years of life lost due to premature mortality—a versatile and comprehensive measure for monitoring non-communicable disease mortality. International journal of epidemiology. 2019;48(4):1367-76. doi:10.1093/ije/dyy254.
Garassino MC, Gadgeel S, Speranza G, Felip E, Esteban E, Domine M, et al. Pembrolizumab plus pemetrexed and platinum in nonsquamous non–small-cell lung cancer: 5-year outcomes from the phase 3 KEYNOTE-189 study. Journal of Clinical Oncology. 2023;41(11):1992-8. doi:10.1200/JCO.22.01989.
Jazieh AR, Algwaiz G, Errihani H, Elghissassi I, Mula-Hussain L, Bawazir AA, et al. Lung Cancer in the Middle East and North Africa Region. J Thorac Oncol. 2019;14(11):1884-91. doi:10.1016/j.jtho.2019.02.016.
Awan KH, Hussain QA, Khan S, Peeran SW, Hamam MK, Hadlaq EA, et al. Accomplishments and challenges in tobacco control endeavors - Report from the Gulf Cooperation Council countries. Saudi Dent J. 2018;30(1):13-8. doi:10.1016/j.sdentj.2017.08.003.
Monshi SS, Ibrahim J. Implementation of tobacco control measures in the Gulf Cooperation Council countries, 2008-2020. Subst Abuse Treat Prev Policy. 2021;16(1):57. doi:10.1186/s13011-021-00393-8.
Araghi M, Fidler-Benaoudia M, Arnold M, Rutherford M, Bardot A, Ferlay J, et al. International differences in lung cancer survival by sex, histological type and stage at diagnosis: an ICBP SURVMARK-2 Study. Thorax. 2022;77(4):378-90. doi:10.1136/thoraxjnl-2020-216555.
Mathur P, Sathishkumar K, Chaturvedi M, Das P, Sudarshan KL, Santhappan S, et al. Cancer statistics, 2020: report from national cancer registry programme, India. JCO global oncology. 2020;6:1063-75. doi:10.1200/GO.20.00122.
Cheng ES, Egger S, Hughes S, Weber M, Steinberg J, Rahman B, et al. Systematic review and meta-analysis of residential radon and lung cancer in never-smokers. European Respiratory Review. 2021;30(159):200-30. doi:10.1183/16000617.0230-2020.
Ghasemiesfe M, Barrow B, Leonard S, Keyhani S, Korenstein D. Association Between Marijuana Use and Risk of Cancer: A Systematic Review and Meta-analysis. JAMA Netw Open. 2019;2(11):e1916318. doi:10.1001/jamanetworkopen.2019.16318.
Pradère P, Marinello A, Vasseur D, Naltet C, Moaca S, Le Pavec J, et al. The impact of dual cannabis and tobacco smoking in young patients with lung cancer: results from the prospective “Environment and Lung
Cancer” study. Chest. 2025;169(3):819-29. doi:10.1016/j.chest.2025.09.017.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49. doi:10.3322/caac.21660.
Islami F, Torre LA, Jemal A. Global trends of lung cancer mortality and smoking prevalence. Transl Lung Cancer Res. 2015;4(4):327-38. doi:10.3978/j.issn.2218-6751.2015.08.04.
Gallus S, Lugo A, Liu X, Behrakis P, Boffi R, Bosetti C, et al. Who Smokes in Europe? Data From 12 European Countries in the TackSHS Survey (2017-2018). J Epidemiol. 2021;31(2):145-51. doi:10.2188/jea.JE20190344.
Malinovska J, Lustigova M, Michalec J, Krollova P, Fruhaufova A, Buckova L, et al. Prevalence of smoking and smoking cessation and associated factors in diabetes population aged 50 years and over in Europe. Scientific Reports. 2025;15(1):14123. doi:10.1038/s41598-025-98876-2.
World Health Organization. Tobacco crisis: WHO European Region projected to remain worst globally by 2030: World Health Organization; 2026 [Available from: https://www.who.int/europe/news/item/26-02-2026-tobaccocrisis--who-european-region-projected-to-remain-worstglobally-by-2030].
Ramalingam SS, Vansteenkiste J, Planchard D, Cho BC, Gray JE, Ohe Y, et al. Overall Survival with Osimertinib in Untreated, EGFR-Mutated Advanced NSCLC. New England Journal of Medicine. 2020;382(1):41-50. doi:10.1056/NEJMoa1913662.
Peshin S, Takrori E, Yazji JH, Haque J, Dharia A, Mithani MS, et al. Advances in Targeted Therapy for Non-Small-Cell Lung Cancer: Current Progress and Future Directions. International Journal of Molecular Sciences. 2025;26(23):11517. doi:10.3390/ijms262311517.
Peng Z, Ding K, Xie M, Xu Y. Efficacy of immunotherapy in RET fusion-positive NSCLC: A meta-analysis. Heliyon. 2024;10(14):e34626. doi:10.1016/j.heliyon.2024.e34626.
Drilon A, Tan DSW, Lassen UN, Leyvraz S, Liu Y, Patel JD, et al. Efficacy and Safety of Larotrectinib in Patients With Tropomyosin Receptor Kinase Fusion-Positive Lung Cancers. JCO Precis Oncol. 2022;6:e2100418. doi:10.1200/PO.21.00418.
Li BT, Smit EF, Goto Y, Nakagawa K, Udagawa H, Mazières J, et al. Trastuzumab Deruxtecan in HER2-Mutant Non-Small-Cell Lung Cancer. N Engl J Med. 2022;386(3):241-51. doi:10.1056/NEJMoa2112431.
Dennis MJ, Abrahami D, Vieira MC, Benjumea D, Boyd M, Shao A, et al. Real-World Analysis of Disparities in Biomarker Testing and Use of Recommended Targeted Therapies in Metastatic Non–Small Cell Lung Cancer in the United States. JCO Precision Oncology. 2025;9:e2400449. doi:10.1200/PO-24-00449.
Howlader N, Forjaz G, Mooradian MJ, Meza R, Kong CY, Cronin KA, et al. The effect of advances in lungcancer treatment on population mortality. New England Journal of Medicine. 2020;383(7):640-9. doi:10.1056/NEJMoa1916623.
Centers for Disease Control and Prevention. U.S. Cancer Statistics Lung Cancer Stat Bite 2025 [Available from: https://www.cdc.gov/united-states-cancer-statistics/publications/lung-cancer-stat-bite.html].
GBD 2019 Tobacco Collaborators. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic
analysis from the Global Burden of Disease Study 2019. Lancet 2021;397(10292):2337. doi:10.1016/S0140-6736(21)01169-7.
Lancaster HL, Heuvelmans MA, Oudkerk M. Low‐dose computed tomography lung cancer screening: Clinical evidence and implementation research. Journal of internal medicine. 2022;292(1):68-80. doi:10.1111/joim.13480.
Tomic K, Begagic E, Voloder E, Naletilic MP, Jozic GB, Cale S, et al. Outcomes of extensive-stage small cell lung cancer treatment in a real-world clinical setting: a single-center experience. Contemp Oncol (Pozn).
2025;29(3):271-80. doi:10.5114/wo.2025.153755.
Burus T, McAfee CR, Knight JR, Mullett TW, Hull PC. Lung Cancer Screening Prevalence and Changes in 2024. JAMA Intern Med. 2026;186(6):775-8. doi:10.1001/jamainternmed.2026.0493.
Brender TD, Richman IB, Gross CP. Lung Cancer Screening Turns 10-Progress and Plenty Left to Do. JAMA Intern Med. 2026;186(6):778-9. doi:10.1001/jamainternmed.2026.0499.
Abdelazeem B, Abbas KS, Labieb F, Arida AK, El-Shahat NA, Shehata J, et al. The role of immunotherapy plus chemotherapy versus chemotherapy alone as first-line treatment for advanced non-small cell lung cancer: an updated systematic review and meta-analysis of randomized controlled trials. Expert Review of Anticancer Therapy. 2022;22(10):1127-40. doi:10.1080/14737140.2022.2116005.
Robbins HA, Alcala K, Swerdlow AJ, Schoemaker MJ, Wareham N, Travis RC, et al. Comparative performance of lung cancer risk models to define lung screening eligibility in the United Kingdom. British Journal of Cancer. 2021;124(12):2026-34. doi:10.1038/s41416-021-01278-0.
Smeltzer MP, Wynes MW, Lantuejoul S, Soo R, Ramalingam SS, Varella-Garcia M, et al. The International Association for the Study of Lung Cancer global survey on molecular testing in lung cancer. Journal of Thoracic Oncology. 2020;15(9):1434-48. doi:10.1016/j.jtho.2020.05.002.
Zhong X, Ji P, Yang L. Small cell lung cancer: from immunobiological mechanisms to clinical advances. Frontiers in Immunology. 2026;17:1765497. doi:10.3389/fimmu.2026.1765497.
Wang BY, Huang JY, Chen HC, Lin CH, Lin SH, Hung WH, et al. The comparison between adenocarcinoma and squamous cell carcinoma in lung cancer patients. Journal of cancer research and clinical oncology. 2020;146(1):43-52. doi:10.1007/s00432-019-03079-8.
Hosgood III HD, Boffetta P, Greenland S, Lee Y-CA, McLaughlin J, Seow A, et al. In-home coal and wood use and lung cancer risk: a pooled analysis of the International Lung Cancer Consortium. Environmental health perspectives. 2010;118(12):1743-7. doi:10.1289/ehp.1002217.
SEER* Explorer: an interactive website for SEER cancer statistics [Internet]. Surveillance Research Program, National Cancer Institute. 2023. Available from: https://seer.cancer.gov/statistics-network/explorer/.
Sant M, Daidone C, Innos K, Marcos-Gragera R, Vanschoenbeek K, Barranco MR, et al. Patterns of care and survival for lung cancer: Results of the European population-based high-resolution study. Front Epidemiol. 2023;3:1109853. doi:10.3389/fepid.2023.1109853.
Evans III N, Grenda T, Alvarez NH, Okusanya OT. Narrative review of socioeconomic and racial disparities in the treatment of early stage lung cancer. Journal of thoracic disease. 2021;13(6):3758-63. doi:10.21037/jtd-20-3181.
Walser T, Cui X, Yanagawa J, Lee JM, Heinrich E, Lee G, et al. Smoking and lung cancer: the role of inflammation. Proc Am Thorac Soc. 2008;5(8):811-5. doi:10.1513/pats.200809-100TH.
World Health Organization. WHO Framework Convention on Tobacco Control. Geneva, Switzerland: World Health Organization; 2003 16 March, 2026.
World Health Organization. 2025 Global Progress Report on Implementation of the WHO Framework Convention on Tobacco Control. Geneva, Switzerland: World Health Organization; 2025.
World Health Organization. WHO global report on trends in prevalence of tobacco use 2000–2030. Geneva: World Health Organization; 2024. 135 p.
6Oberg M, Jaakkola MS, Woodward A, Peruga A, Pruss-Ustun A. Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. The lancet. 2011;377(9760):139-46. doi:10.1016/S0140-6736(10)61388-8.
Office on Smoking and Health (US). The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2006.
Yousuf H, Hofstra M, Tijssen J, Leenen B, Lindemans JW, van Rossum A, et al. Estimated worldwide mortality attributed to secondhand tobacco smoke exposure, 1990-2016. JAMA network open. 2020;3(3):e201177. doi:10.1001/jamanetworkopen.2020.1177.
Zhang Y, Wang W, Dai K, Huang Y, Wang R, He D, et al. Global lung cancer burden attributable to air fine particulate matter and tobacco smoke exposure: spatiotemporal patterns, sociodemographic characteristics, and transnational inequalities from 1990 to 2021. BMC Public Health. 2025;25(1):1260. doi:10.1186/s12889-025-22450-8.
World Health Organization. Household air pollution Geneva, Switzerland: World Health Organization; 2025 [updated 16 December 2025. Available from: https://www.who.int/news-room/fact-sheets/detail/
household-air-pollution-and-health].
World Health Organization. WHO guidelines for indoor air quality: household fuel combustion. Geneva: World Health Organization; 2014. 172 p.
Roder D, Buckley E. Monitoring Therapeutic Side Effects (carcinogenic and non-carcinogenic) with Linked Cancer Registry Data in Australia. Asian Pacific Journal of Environment and Cancer. 2021;4(1):39-43. doi:10.31557/apjec.2021.4.1.39-43.
IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Chemical agents and related occupations. Lyon (France): International Agency for Research on Cancer; 2012.
Ge C, Peters S, Olsson A, Portengen L, Schuz J, Almansa J, et al. Diesel Engine Exhaust Exposure, Smoking, and Lung Cancer Subtype Risks. A Pooled Exposure-Response Analysis of 14 Case-Control Studies. Am J Respir Crit Care Med. 2020;202(3):402-11. doi:10.1164/rccm.201911-2101OC.
Tomalieh BT, Torres Luna JD, Murugesan K, Kabir A, Rebellow D, Kasagga A, et al. PET/CT vs PET/MRI in Lung Cancer: A Narrative Review of Diagnostic Performance, Practical Trade-offs, and Clinical Impact. Cureus. 2025;17(9):e93427-e. doi:10.7759/cureus.93427.
Postmus PE, Kerr KM, Oudkerk M, Senan S, Waller DA, Vansteenkiste J, et al. Early and locally advanced nonsmall-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of oncology. 2017;28(suppl_4):iv1-iv21. doi:10.1093/annonc/mdx222.
Bracken-Clarke D, Kapoor D, Baird AM, Buchanan PJ, Gately K, Cuffe S, et al. Vaping and lung cancer - A review of current data and recommendations. Lung Cancer. 2021;153:11-20. doi:10.1016/j.lungcan.2020.12.030.
Khodaee A, Reed A, Khodaee M. Electronic Cigarette Use (Vaping) Among Adolescents: A Narrative Review of an Emerging Public Health Epidemic. Cureus. 2025;17(8):e89422. doi:10.7759/cureus.89422.
Cote ML, Liu M, Bonassi S, Neri M, Schwartz AG, Christiani DC, et al. Increased risk of lung cancer in individuals with a family history of the disease: a pooled analysis from the International Lung Cancer Consortium. European journal of cancer. 2012;48(13):1957-68. doi:10.1016/j.ejca.2012.01.038.
Mucci LA, Hjelmborg JB, Harris JR, Czene K, Havelick DJ, Scheike T, et al. Familial risk and heritability of cancer among twins in Nordic countries. JAMA. 2016;315(1):68-76. doi:10.1001/jama.2016.0197.
Hung RJ, Warkentin MT, Brhane Y, Chatterjee N, Christiani DC, Landi MT, et al. Assessing lung cancer absolute risk trajectory based on a polygenic risk model. Cancer research. 2021;81(6):1607-15. doi:10.1158/0008-5472. CAN-20-1237.
McKay JD, Hung RJ, Han Y, Zong X, Carreras-Torres R, Christiani DC, et al. Large-scale association analysis identifies new lung cancer susceptibility loci and heterogeneity in genetic susceptibility across histological subtypes. Nat Genet. 2017;49(7):1126-32. doi:10.1038/ng.3892.
Dai J, Lv J, Zhu M, Wang Y, Qin N, Ma H, et al. Identification of risk loci and a polygenic risk score for lung cancer: a large-scale prospective cohort study in Chinese populations. The Lancet Respiratory Medicine. 2019;7(10):881-91. doi:10.1016/S2213-2600(19)30144-4.
Li S, Li L, Zhu Y, Huang C, Qin Y, Liu H, et al. Coexistence of EGFR with KRAS, or BRAF, or PIK3CA somatic mutations in lung cancer: a comprehensive mutation profiling from 5125 Chinese cohorts. British journal of cancer. 2014;110(11):2812-20. doi:10.1038/bjc.2014.210.
Zhang YL, Yuan JQ, Wang KF, Fu XH, Han XR, Threapleton D, et al. The prevalence of EGFR mutation in patients with non-small cell lung cancer: a systematic review and meta-analysis. Oncotarget. 2016;7(48):78985. doi:10.18632/oncotarget.12587.
AACR Project Genie Consortium. AACR Project GENIE: Powering Precision Medicine through an International Consortium. Cancer discovery. 2017;7(8):818-31. doi:10.1158/2159-8290.CD-17-0151.
Dogan S, Shen R, Ang DC, Johnson ML, D’Angelo SP, Paik PK, et al. Molecular epidemiology of EGFR and KRAS mutations in 3,026 lung adenocarcinomas: higher susceptibility of women to smoking-related KRAS-mutant cancers. Clinical cancer research. 2012;18(22):6169-77. doi:10.1158/1078-0432.CCR-11-3265.
Young RP, Hopkins RJ, Christmas T, Black PN, Metcalf P, Gamble GD. COPD prevalence is increased in lung cancer, independent of age, sex and smoking history. Eur Respir J. 2009;34(2):380-6. doi:10.1183/09031936.00144208.
de Torres JP, Marín JM, Casanova C, Cote C, Carrizo S, Cordoba-Lanus E, et al. Lung cancer in patients with chronic obstructive pulmonary disease- incidence and predicting factors. Am J Respir Crit Care Med.
2011;184(8):913-9. doi:10.1164/rccm.201103-0430OC.
Sigel K, Makinson A, Thaler J. Lung cancer in persons with HIV. Curr Opin HIV AIDS. 2017;12(1):31-8. doi:10.1097/COH.0000000000000326.
Shiels MS, Cole SR, Mehta SH, Kirk GD. Lung cancer incidence and mortality among HIV-infected and HIV-uninfected injection drug users. J Acquir Immune Defic Syndr. 2010;55(4):510-5. doi:10.1097/QAI.0b013e3181f53783.
Sigel K, Wisnivesky J, Gordon K, Dubrow R, Justice A, Brown ST, et al. HIV as an independent risk factor for incident lung cancer. AIDS. 2012;26(8):1017-25. doi:10.1097/QAD.0b013e328352d1ad.
Wei X, Zhu C, Ji M, Fan J, Xie J, Huang Y, et al. Diet and Risk of Incident Lung Cancer: A Large Prospective Cohort Study in UK Biobank. Am J Clin Nutr. 2021;114(6):2043-51. doi:10.1093/ajcn/nqab298.
Xue XJ, Gao Q, Qiao JH, Zhang J, Xu CP, Liu J. Red and processed meat consumption and the risk of lung cancer: a dose-response meta-analysis of 33 published studies. Int J Clin Exp Med. 2014;7(6):1542-53. PMC4100964.
Alpha-Tocopherol Beta Carotene Cancer Prevention Study Group. The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med. 1994;330(15):1029-35. doi:10.1056/nejm199404143301501.
Omenn GS, Goodman GE, Thornquist MD, Balmes J, Cullen MR, Glass A, et al. Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. N Engl J Med. 1996;334(18):1150-5. doi:10.1056/NEJM199605023341802.
Starkey F, Moore L, Campbell R, Sidaway M, Bloor M. Rationale, design and conduct of a comprehensive evaluation of a school-based peer-led anti-smoking intervention in the UK: the ASSIST cluster randomised trial [ISRCTN55572965]. BMC Public Health. 2005;5:43. doi:10.1186/1471-2458-5-43.
Lewis KE, Ravara SB, Papadakis S, Attar-Zadeh D, Hanafin J, Clancy L, et al. Optimising health systems to deliver tobacco-dependence treatment. Supporting Tobacco Cessation Sheffield, UK European Respiratory Society; 2021. p. 118-35. doi:10.1183/2312508X.10002520.
Theobald M, Botelho R, Saccocio S, Houston T, McAfee T, Mullins S, et al. Treating tobacco dependence practice manual, a systems-change approach. Am Acad Fam Phys. 2017.
Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-e646. doi:10.1161/CIR.0000000000000678.
Neff LJ, Patel D, Davis K, Ridgeway W, Shafer P, Cox S. Evaluation of the National Tips From Former Smokers Campaign: the 2014 Longitudinal Cohort. Prev Chronic Dis. 2016;13:E42. doi:10.5888/pcd13.150556.
Akter S, Rahman MM, Rouyard T, Aktar S, Nsashiyi RS, Nakamura R. A systematic review and network meta-analysis of population-level interventions to tackle smoking behaviour. Nat Hum Behav. 2024;8(12):2367-91. doi:10.1038/s41562-024-02002-7.
Quansah R, Semple S, Ochieng CA, Juvekar S, Armah FA, Luginaah I, et al. Effectiveness of interventions to reduce household air pollution and/or improve health in homes using solid fuel in low-and-middle income countries: A systematic review and meta-analysis. Environ Int. 2017;103:73-90. doi:10.1016/j.envint.2017.03.010.
Samarzija M, Krpina K, Marusic A, Jakopovic M, Aboud A, Kukuljan M, et al. Design of the first national lung cancer screening program in the European Union: the Croatian Model. Eur Radiol. 2026;36(5):4090-7. doi:10.1007/s00330-025-12185-w.
Lung Cancer Policy Network. Lung cancer screening in Croatia: leading the way for earlier detection in Europe: Lung Cancer Policy Network; 2023 [Available from: https://www.lungcancerpolicynetwork.com/
lung-cancer-screening-in-croatia/].
Lung Cancer Policy Network. Paving the way for lung cancer screening: learning from Central and Eastern Europe: Lung Cancer Policy Network; 2024 [Available from: https://www.lungcancerpolicynetwork.com/paving-the-way-for-lung-cancer-screening-learning-fromcentral-and-eastern-europe/].
Vasakova MK, Hejduk K, Kocova E, Cierna Peterova I, Mirka H, Seifert B, et al. Experience With Lung Cancer Screening in the Czech Republic: Half-time of the National Pilot Programme. American Journal of Respiratory and Critical Care Medicine. 2025;211(Supplement_1):A5215-A. doi:10.1164/ajrccm.2025.211.Abstracts.A5215.
Ministry of Health Republic of Poland. Lung cancer screening program gov.pl: Ministerstwo Zdrowia; [Available from: https://www.gov.pl/web/zdrowie/program-badan-w-kierunku-wykrywania-raka-pluca].
Kerpel-Fronius A, Bogos K. HUNCHEST projectsadvancing low-dose CT lung cancer screening in Hungary. Pathol Oncol Res. 2024;30:1611635. doi:10.3389/pore.2024.1611635.
OECD/European Commission. EU Country Cancer Profile: Italy 2025. Paris; 2025.
Lung Cancer Screening Pilot Programme: Cancer Screening Smoking Cessation AND Respiratory Assessment (CASSANDRA) [Internet]. 2023. Available from: https://clinicaltrials.gov/study/NCT06157957.
Federal Ministry for the Environment Nature Conservation Nuclear Safety and Consumer Protection. Regulation on the admissibility of the use of low-dose computed tomography for the early detection of lung cancer in smokers 1 (Lung Cancer Early Detection Regulation - LuKrFrüh-ErkV): Bundesministerium der Justiz / Bundesamt für Justiz; 2024 [Available from: https://www.gesetze-im-internet.de/lukrfr_herkv/BJNR0A20A0024.html ].
Force USPST, Krist AH, Davidson KW, Mangione CM, Barry MJ, Cabana M, et al. Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;325(10):962-70. doi:10.1001/jama.2021.1117.
Passiglia F, Cinquini M, Bertolaccini L, Del Re M, Facchinetti F, Ferrara R, et al. Benefits and harms of lung cancer screening by chest computed tomography: a systematic review and meta-analysis. Journal of Clinical Oncology. 2021;39(23):2574-85. doi:10.1200/JCO.21.02078.
Rasmussen JF, Siersma V, Malmqvist J, Brodersen J. Psychosocial consequences of false positives in the Danish Lung Cancer CT Screening Trial: a nested matched cohort study. BMJ open. 2020;10(6):e034682. doi:10.1136/bmjopen-2019-034682.
dos Santos RS, Franceschini JP, Chate RC, Ghefter MC, Kay F, Trajano AL, et al. Do Current Lung Cancer Screening Guidelines Apply for Populations With High Prevalence of Granulomatous Disease? Results From the First Brazilian Lung Cancer Screening Trial (BRELT1). Ann Thorac Surg. 2016;101(2):481-6; discussion 7-8. doi:10.1016/j.athoracsur.2015.07.013.
Wade S, Weber M, Caruana M, Kang YJ, Marshall H, Manser R, et al. Estimating the cost-effectiveness of lung cancer screening with low-dose computed tomography for high-risk smokers in Australia. Journal of
Thoracic Oncology. 2018;13(8):1094-105. doi:10.1016/j.jtho.2018.04.006.
Pan X, Dvortsin E, Baldwin DR, Groen HJM, Ramaker D, Ryan J, et al. Cost-effectiveness of volume computed tomography in lung cancer screening: a cohort simulation based on Nelson study outcomes. Journal of medical economics. 2024;27(1):27-38. doi:10.1080/13696998.2023.2288739.
Fan Z, Zheng M, Guan Z, Liu H, Guo P, Zhu Y, et al. Costeffectiveness of lung cancer screening: insights from risk stratification, guidelines, and emerging technologies—a systematic review. npj Primary Care Respiratory Medicine. 2026;36(1):15. doi:10.1038/s41533-026-00482-w.
Grover H, Ross T, Fuller E. Implementation of targeted screening for lung cancer in a high-risk population within routine NHS practice using low-dose computed tomography. Thorax. 2020;75(4):348-50. doi:10.1136/thoraxjnl-2019-214303.
See KC. Reducing the burden of lung cancer through primary, secondary, tertiary and quaternary prevention. Singapore Medicine Journal. 2025;66(11):584-5. doi:10.4103/SINGAPOREMEDJ.SMJ-2025-243.
Hubbell E, Clarke CA, Aravanis AM, Berg CD. Modeled reductions in late-stage cancer with a multi-cancer early detection test. Cancer Epidemiology, Biomarkers & Prevention. 2021;30(3):460-8. doi:10.1158/1055-9965.EPI-20-1134.
Hackshaw A, Cohen SS, Reichert H, Kansal AR, Chung KC, Ofman JJ. Estimating the population health impact of a multi-cancer early detection genomic blood test to complement existing screening in the US and UK. British Journal of Cancer. 2021;125(10):1432. doi:10.1038/s41416-021-01498-4.
Charlton ME, Kahl AR, McDowell BD, Miller RS, Komatsoulis G, Koskimaki JE, et al. Cancer registry data linkage of electronic health record data from ASCO’s CancerLinQ: Evaluation of advantages, limitations,
and lessons learned. JCO clinical cancer informatics. 2022;6:e2100149. doi:10.1200/CCI.21.00149.
Ngoc LTN, Park D, Lee YC. Human health impacts of residential radon exposure: updated systematic review and meta-analysis of case–control studies. International Journal of Environmental Research and Public Health. 2022;20(1):97. doi:10.3390/ijerph20010097.
Febbraro M, Gheware A, Kennedy T, Jain D, de Moraes FY, Juergens R, editors. Barriers to Access: Global Variability in Implementing Treatment Advances in Lung Cancer. American Society of Clinical Oncology Educational book American Society of Clinical Oncology Annual Meeting; 2022. doi: 10.1200/EDBK_351021.
Tsimberidou AM, Kahle M, Vo HH, Baysal MA, Johnson A, Meric-Bernstam F. Molecular tumour boards - current and future considerations for precision oncology. Nat Rev Clin Oncol. 2023;20(12):843-63. doi:10.1038/s41571-023-00824-4.
Vashistha V, Katsoulakis E, Guo A, Price M, Ahmed S, Kelley MJ. Molecular-Guided Off-Label Targeted Therapy in a Large-Scale Precision Oncology Program. JCO Precis Oncol. 2023;7:e2200518. doi:10.1200/
PO.22.00518.
Edwards DM, Pirzadeh M, Van T, Jiang R, Tate A, Schaefer G, et al. Impact of lung cancer screening on stage migration and mortality among the national Veterans Health Administration population with lung cancer. Cancer. 2024;130(17):2910-7. doi:10.1002/cncr.35340.
National Lung Screening Trial Research T, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, et al. Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening. New England Journal of Medicine. 2011;365(5):395-409. doi:10.1056/NEJMoa1102873.
U.S. Cancer Statistics Working Group. United States Cancer Statistics: Data Visualizations: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2025 [Available from: https://www.cdc.gov/cancer/dataviz].
Tucker-Seeley R, Abu-Khalaf M, Bona K, Shastri S, Johnson W, Phillips J, et al. Social Determinants of Health and Cancer Care: An ASCO Policy Statement. JCO Oncol Pract. 2024;20(5):621-30. doi:10.1200/OP.23.00810.
Shehata DG, Pan JM, Pan Z, Vigneswaran J, Contreras N, Rodriguez E, et al. Equity and Opportunities in Lung Cancer Care-Addressing Disparities, Challenges, and Pathways Forward. Cancers (Basel). 2025;17(8).
doi:10.3390/cancers17081347.
Zeng H, Yuan Z, Zhang G, Li W, Guo L, Li N, et al. Racial disparities in histological subtype, stage, tumor grade and cancer-specific survival in lung cancer. Transl Lung Cancer Res. 2022;11(7):1348-58. doi:10.21037/tlcr-21-794.
Shusted CS, Evans NR, Kane GC, Juon HS, Barta JA. Analysis of Lung Cancer Screening by Race After USPSTF Expansion of Screening Eligibility in 2021. JAMA Netw Open. 2022;5(6):e2217578. doi:10.1001/jamanetworkopen.2022.17578.
Monestime S, Rigney M, Phipps N, Carlson C, Alongi T, Redding M, et al. Health inequities across the lung cancer care continuum in ten marginalized populations: a narrative review. J Thorac Dis. 2023;15(11):6345-61. doi:10.21037/jtd-23-727.
Gargapati A, Fox J, Massarelli E. Disparities in Lung Cancer Health Outcomes and Access to Lung Cancer Screening Between Rural and Urban Areas in the U.S. Cancers (Basel). 2026;18(5):864. doi:10.3390/cancers18050864.
Redondo-Sánchez D, Petrova D, Rodríguez-Barranco M, Fernández-Navarro P, Jiménez-Moleón JJ, Sánchez M-J. Socio-Economic Inequalities in Lung Cancer Outcomes: An Overview of Systematic Reviews. Cancers (Basel). 2022;14(2). doi:10.3390/cancers14020398.
International Criminal Tribunal for the former Yugoslavia. The Conflicts United Nations International Residual Mechanism for Criminal Tribunals: United Nations; n.d. [Available from: https://www.icty.org/en/about/what-former-yugoslavia/conflicts].
Ilic M, Ilic I. Cancer mortality in Serbia, 1991-2015: an age-period-cohort and joinpoint regression analysis. Cancer Commun (Lond). 2018;38(1):10. doi:10.1186/s40880-018-0282-3.
International Monetary Fund. Former Yugoslav Republic of Macedonia: Staff Report for the 2009 Article IV Consultation—Staff Report; Staff Statement; Public Information Notice on the Executive Board Discussion; and Statement by the Executive Director for the Former Yugoslav Republic of Macedonia. Washington, D.C.: International Monetary Fund; 2010 January 2010.
U.S. Department of State. Bosnia Fact Sheet: Economic Sanctions Against the Federal Republic of Yugoslavia (Serbia and Montenegro) U.S. Department of State Archive: Bureau of Public Affairs, U.S. Department of State; 1995 [updated November 13, 1995 May 13, 2026]. Available from: https://1997-2001.state.gov/regions/eur/bosnia/yugoslavia_econ_sanctions.html].
United Nations High Commissioner for Refugees (UNHCR). Internally displaced persons. The State of the World’s Refugees 2006: Human Displacement in the New Millennium. Geneva: UNHCR; 2006.
Bozicevic I, Gilmore A, Oreskovic S. The tobacco epidemic in south-east Europe: consequences and policy responses. 2004. doi:10.1596/13710.
Al-Ali N, Black R, Koser K. Refugees and transnationalism: The experience of Bosnians and Eritreans in Europe. Journal of Ethnic and Migration studies. 2001;27(4):615-34. doi:10.1080/13691830120090412.
De Haas H, Vezzoli S. European Migrations: Dynamics, drivers, and the role of policies. 2018. doi:10.2760/168653.
Miao J, Guan W, Wang J, Gong H, Xie Q, Gao Y. Multiomics integration in deciphering non-small cell lung cancer drug resistance: current status, challenges, and future prospects. Hereditas. 2026;163(1):5. doi:10.1186/s41065-025-00570-w.
Downloads
Published
License
Copyright (c) 2026 Shahd Hamran, Zaineh Alnoubani, Raghad Elsherif, Zoran Gatalica, Semir Vranic, Giridhara Rathnaiah Babu
This work is licensed under a Creative Commons Attribution 4.0 International License.
