Epidemiology and Prevention of Lung Cancer in Europe: A Review of Burden, Disparities, and the Path to Equitable Early Detection.

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 multilevel 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.