What is the European Code Against Cancer and how does it impact our approach to patient care?
ECAC is a long-standing initiative of the European Commission that provides comprehensive, evidence-based actionable recommendations on cancer to European citizens and policymakers. The first Code was produced in 1987, and the 5th edition was published in late 2025. The ECAC informs citizens on how to reduce their cancer risk, through primary prevention and on early detection through screening. Given that an estimated 44% of cancer deaths are preventable and currently 12% of premature deaths are averted in Europe, the Code provides advice on measures to maintain and improve these outcomes. The code applies to European member states but is an important reference for other countries because of the robust methodology and careful attention to evidence. Hence the Code avoids recommendations where there is uncertainty, and this was indeed the case with the 5th Edition.
How has the latest version addressed lung cancer and lung cancer screenings?
ECAC 5 includes, for the first time, a firm recommendation to screen for lung cancer. This is given the same weight as the other recommended programmes for bowel, breast and cervical cancer. Citizens are advised to “take part in organised screening programmes for lung cancer, as recommended in your country”. Countries are advised to offer organised lung cancer screening programmes within the constraints of capacity and healthcare priorities. The basis for this change was a review of the evidence for lung cancer screening and whilst more recent that for other screening programmes, it was noted that the evidence was strong. The fact that the pooled results of randomised trials show an 5% reduction in all-cause mortality was something not seen in similar trials for the other programmes.
Annual or biennial screening with low radiation-dose computed tomography with integrated smoking cessation is recommended for people at high risk of developing lung cancer. The risk may be defined by age and smoking criteria alone or by multivariable risk prediction models.
What are the general developments in lung cancer screenings in the UK?
The UK has moved from a pilot randomised controlled trial that started in 2010, through small pilot programmes and other research trials from 2015 onwards through to the large-scale pilot, the Targeted Lung Health Check (TLHC) and is now in full national programme roll out in England. The pilots and other research trials provided real-world evidence for feasibility and important information used to optimise screening protocols. The decision to invest in the TLHC was taken by NHS England over 2 years ahead of the formal recommendation by the UK National Screening Committee. The latter commissioned a detailed revised health economics analysis that concluded that lung cancer screening was cost seamlessly transitioned into the English screening programme. Almost half of the potentially eligible population have been invited and full roll-out is expected in 2030 and government funding confirmed. Over 9000 people have been diagnosed with lung cancer with 62% at stage I and 14% at stage II. In Wales, a large pilot has evaluated well, and the full programme will start in 2027 with full roll out by 2033. In Scotland and Northern Ireland, there is government approval and active planning but at the time of writing no confirmed dates.
How do you expect the ECAC 5 to impact and influence the landscape of lung cancer screenings in the UK?
The ECAC 5’s significance will undoubtedly have the most impact in Europe, but it will also provide further impetus for implementation, hopefully at a faster pace than we are seeing in some parts of the UK. Implementing an intervention proven to save lives must be a priority in healthcare as so much of what is done does not have a firm evidence base. The example the British programme has set for rapid, large-scale implementation and the encouraging results so far, will, in combination with guidance such as ECAC 5, move individuals and countries from the mindset of whether to implement, to how.