Adoption rates of lung cancer screening internationally and disparities in high-prevalence countries by income level.

294 Background: Lung cancer remains the leading cause of cancer-related deaths worldwide, largely due to tobacco use. The National Lung Cancer Screening Trial showed that annual low-dose CT (LDCT) screening reduces lung cancer mortality. The NELSON trial showed similar results in Europe. However, guidelines and implementation vary globally. The U.S. Preventive Services Task Force recommends annual LDCT screening for individuals aged 55–80 with a 30-pack-year smoking history. We aim to compare the current status of lung cancer screening in high-prevalence countries across income groups. Methods: We selected 18 countries—six with the highest lung cancer prevalence from each of three World Bank income groups: High (HI), Upper-Middle (UMI), and Lower-Middle Income (LMI). Data sources included GLOBOCAN 2023 (incidence), WHO (smoking prevalence), and national health portals (screening programs, modalities and guidelines). Results: HI countries had an average smoking prevalence of 22.45%. Three of six had national screening programs, with two approved recently and undergoing gradual implementation. Despite existence of formal programs (e.g., in U.S.A), uptake remained low—16% of eligible adults—due to geographic, insurance, and access barriers. France evaluated biennial screening, without implementation of a program. Germany’s new program, not yet part of standard care, aimed to utilise artificial intelligence. Japan preferred to use X-rays and sputum cytology and had the highest screening rates among analysed countries. In selected UMI countries, lung cancer incidence (241,645 cases) and smoking prevalence (25%) were higher than in HI counterparts. One of six had a national program. China’s LDCT initiatives included mobile units and artificial intelligence. LMI countries had some of the highest smoking rates (e.g., Bangladesh: 43.7%) but no organised programs or formal guidelines. Screening was limited to select private centres and usually voluntary. International guidelines were not reproducible, and the high tuberculosis burden increased false positives on LDCT adding to the challenge. Formal screening remained absent in UMI and LMI nations. Conclusions: Uptake of lung cancer screening remains low in HI countries, with varied implementation, highlighting cultural and economic barriers. Disparities in lung cancer screening are significant in LMI and UMI countries despite high tobacco burden. Addressing these inequities requires context-specific strategies, infrastructure investment, and integration of emerging technologies to expand access and improve early detection worldwide.