Feasibility assessment of implementing lung cancer screening among current and former heavy smokers: a national pilot program in Israel (2021-2024).

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.