Beyond the Scan - Adapting Multimodal Lung Cancer Screening for Central and Eastern Europe - Overcoming Systemic Barriers and Epidemiological Confounders

Sep 22, 2026

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Lung cancer is the leading cause of cancer-related mortality in Central and Eastern Europe, where late-stage diagnosis, structural healthcare limits, and regional epidemiological confounders hinder early detection. This structured review synthesizes evidence from Romania, Poland, Hungary, and Bulgaria to design a context-adapted multimodal screening strategy. Review methods cover 2010–27 December 2025 literature on epidemiology, implementation barriers, risk stratification, and adjunctive diagnostics. Findings show persistent late-stage burden and reduced specificity from TB-related granulomatous lesions, supporting multimodal, risk-based LDCT with centralized multidisciplinary delivery.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages42

Reading Time1 h 46 min

AccessFree to download

Abstract

Background/Objectives

Methods

Results

Conclusions

Introduction

Review Beyond the Scan: Adapting Multimodal Lung Cancer Screening for Central and Eastern Europe—Overcoming Systemic Barriersand Epidemiological Confounders Rodica Anghel 1, Antonia-Ruxandra Folea 1,2, *, Vlad-Luca Moga 1,2, Cristian Pavel 1,2, Diana Troncotă 1, Matei Celea 2, Corneliu-Octavian Dumitru 3, Andreea-Iren S, erban 4,5 and Liviu Bîlteanu 1,5,6 Academic Editor: Ravi P. Sahu Received: 25 March 2026 Revised: 6 May 2026 Accepted: 14 May 2026 Published: 18 May 2026 Copyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Street, 050474 Bucharest, Romania; rodica.anghel@umfcd.ro (R.A.); [vlad-luca.moga@drd.umfcd.ro](vlad-luca.moga@drd.umfcd.ro) (V.-L.M.); [cristian-pavel.pavel@drd.umfcd.ro](cristian-pavel.pavel@drd.umfcd.ro) (C.P.); diana.troncota@drd.umfcd.ro (D.T.); [liviu.bilteanu@umfcd.ro](liviu.bilteanu@umfcd.ro) (L.B.) 2 Oncological Institute “Alexandru Trestioreanu” Bucharest, 252 Soseaua Fundeni, 022328 Bucharest, Romania; [mateicelea@gmail.com](mateicelea@gmail.com) 3 Remote Sensing Technology Institute, German Aerospace Center, Münchener Str. 20, 82234 Wessling, Germany; [corneliu.dumitru@dlr.de](corneliu.dumitru@dlr.de) 4 Department of Preclinical Sciences, Faculty of Veterinary Medicine, University of Agronomic Sciences and Veterinary Medicine, 105 Splaiul Independentei, 050097 Bucharest, Romania; [andreea-iren.serban@fmvb.usamv.ro](andreea-iren.serban@fmvb.usamv.ro) 5 Faculty of Biology, University of Bucharest, 91-95 Splaiul Independentei, 050095 Bucharest, Romania 6 Laboratory for Molecular Nanotechnologies, National Institute for Research and Development in Microtechnologies—IMT Bucharest, 126A, Erou Iancu Nicolae Street, 077190 Voluntari, Romania * Correspondence: [antonia-ruxandra.folea@drd.umfcd.ro](antonia-ruxandra.folea@drd.umfcd.ro) Abstract Background/Objectives: Lung cancer remains the leading cause of cancer-related mortality in Central and Eastern Europe (CEE), where late-stage diagnosis, structural healthcare limitations, and regional epidemiological confounders complicate early detection. This review aimed to synthesize the evidence from Romania, Poland, Hungary, and Bulgaria and to outline a context-adapted multimodal screening strategy for CEE settings. Methods: A structured review of PubMed-, Scopus-, and Web of Science-indexed literature published from 2010 through 27 December 2025 was performed, focusing on lung cancer epidemiology, screening, implementation barriers, risk stratification, and adjunctive diagnostic approaches in the four selected CEE countries. A total of 297 articles were included. Results: The evidence confirms a persistently high burden of late-stage lung cancer across CEE, driven by tobacco exposure, air pollution, radon, comorbidities, diagnostic delays, fragmented registries, workforce shortages, and marked socioeconomic and geographic inequalities. In addition, tuberculosis-related granulomatous lesions and chronic inflammatory lung disease complicate nodule interpretation and reduce screening specificity in parts of the region. Screening experience from Poland and Hungary supports the feasibility of low-dose computed tomography (LDCT) when paired with volumetric assessment and structured follow-up. Risk-prediction models may improve participant selection, while biological triage may help reduce unnecessary invasive procedures, although prospective validation remains limited. Conclusions: In CEE, lung cancer screening should be implemented as a multimodal, context-adapted program combining risk-based enrollment, volumetric LDCT, selective biological triage, smoking-cessation support, and centralized multidisciplinary delivery. Keywords: low-dose computed tomography; lung cancer screening;

FAQs

Why is early lung cancer detection challenging in Central and Eastern Europe?

Late-stage presentation is driven by structural healthcare limitations, diagnostic delays, and regional epidemiological confounders that complicate screening and risk identification.

What did the review analyze and how many studies were included?

It reviewed PubMed, Scopus, and Web of Science literature from 2010 through 27 December 2025 on epidemiology, screening barriers, risk stratification, and adjunctive diagnostics, including 297 articles.

Which key screening approach is recommended for CEE settings?

Implement a multimodal, context-adapted program combining risk-based enrollment, volumetric LDCT, selective biological triage, smoking-cessation support, and centralized multidisciplinary delivery.

Sep 22, 2026

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