Lung cancer (Amsterdam, Netherlands) · 2026
Feasibility assessment of implementing lung cancer screening among current and former heavy smokers: a national pilot program in Israel (2021-2024).
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Maya Rodnay, Liora Valinsky, Dorith Shaham, Amir Onn, Irit Cohen-Manheim, Michal Bromberg, Maya Ben-Lassan, Lital Keinan-Boker, Elad Zribi, Nina Hakak, Osnat Luxenburg
Аннотация
BACKGROUND: Following international evidence supporting low-dose computed tomography (LDCT), the Israel Ministry of Health (MOH) established the TIGAR pilot program to assess the feasibility of implementing a national LDCT screening program for high-risk populations, aligned with contemporary frameworks for screening implementation.
METHODS: The pilot (2021-2024) was coordinated nationally in collaboration with all four Israeli Health Maintenance Organizations (HMOs). The evaluation was guided by the framework of Dobrow et al., which assesses three domains: condition, intervention, and system. LDCT scans were interpreted using Lung-RADS criteria. Data were centrally collected through a national registry. Analyses evaluated participation, test performance, follow-up, and timeliness of care.
RESULTS: A total of 5,395 individuals underwent LDCT screening. Among eligible individuals, participation reached 50.5%. A total of 63 (1.2%) lung cancer cases were detected, of witch them 57.9% were diagnosed at an early disease stage (I-II). The positive predictive value was 11.6% for Lung-RADS ≥ 3 and 54.2% for highly suspicious nodules (4b/4x). False-positive rates were 8.4% and 0.7%, respectively, with no immediate serious complications observed. Median time from abnormal LDCT to diagnostic procedure was 6.4 weeks (IQR 3.5-14.1). Key system challenges included incomplete smoking documentation, variable uptake across HMOs, and limited radiologist capacity for double reading. Proactive engagement and centralized coordination markedly improved participation and timeliness.
CONCLUSIONS: The TIGAR pilot demonstrated that LDCT lung cancer screening in Israel is feasible, acceptable to current and former smokers, and effective in detecting early-stage disease, with minimal harm, primarily related to false-positive results and incidental findings. Based on these findings, LDCT screening for high-risk individuals aged 65-74 was approved for inclusion in Israel's National List of Health Services Public Committee effective September 2025, with an expansion to individuals aged 60-74 in 2026. The TIGAR pilot provides a foundation for nationwide implementation.
METHODS: The pilot (2021-2024) was coordinated nationally in collaboration with all four Israeli Health Maintenance Organizations (HMOs). The evaluation was guided by the framework of Dobrow et al., which assesses three domains: condition, intervention, and system. LDCT scans were interpreted using Lung-RADS criteria. Data were centrally collected through a national registry. Analyses evaluated participation, test performance, follow-up, and timeliness of care.
RESULTS: A total of 5,395 individuals underwent LDCT screening. Among eligible individuals, participation reached 50.5%. A total of 63 (1.2%) lung cancer cases were detected, of witch them 57.9% were diagnosed at an early disease stage (I-II). The positive predictive value was 11.6% for Lung-RADS ≥ 3 and 54.2% for highly suspicious nodules (4b/4x). False-positive rates were 8.4% and 0.7%, respectively, with no immediate serious complications observed. Median time from abnormal LDCT to diagnostic procedure was 6.4 weeks (IQR 3.5-14.1). Key system challenges included incomplete smoking documentation, variable uptake across HMOs, and limited radiologist capacity for double reading. Proactive engagement and centralized coordination markedly improved participation and timeliness.
CONCLUSIONS: The TIGAR pilot demonstrated that LDCT lung cancer screening in Israel is feasible, acceptable to current and former smokers, and effective in detecting early-stage disease, with minimal harm, primarily related to false-positive results and incidental findings. Based on these findings, LDCT screening for high-risk individuals aged 65-74 was approved for inclusion in Israel's National List of Health Services Public Committee effective September 2025, with an expansion to individuals aged 60-74 in 2026. The TIGAR pilot provides a foundation for nationwide implementation.