Strategies for sustainable lung cancer screening: a multi-faceted perspective to long-term surveillance in SOLACE

Lung cancer is the leading cause of cancer-related deaths globally. To detect lung cancer at an earlier, treatable stage, low-dose chest CT is a critical tool for risk-based lung cancer screening. With the growing large-scale, multidisciplinary support for the implementation of lung cancer screening, it is important to ensure these programmes are implemented in a sustainable and effective manner. This review focuses on the three fundamental dimensions of sustainability: ecological, social, and economic. It examines strategies for their effective implementation in accordance with current best practices. Ecological sustainability involves reducing energy use and emissions and leveraging technological innovations to positively impact the environment. Economic sustainability highlights the need to evaluate long-term financial capacity and infrastructure and the role of effective risk-stratification. Social sustainability centres on equitable access to lung cancer screening programmes, particularly for currently underserved populations, with a focus on targeted recruitment strategies. We present an overview of current challenges, an analysis of best practices, and examples of real-world implementation, with a particular emphasis on initiatives in the SOLACE project. CLINICAL RELEVANCE STATEMENT: This review highlights the importance of a multidisciplinary and sustainable approach to implementing lung cancer screening by integrating ecological, economic and social sustainability practices. KEY POINTS: Lung cancer screening requires balanced consideration of all three sustainability pillars: ecological, economic, and social. This review examines sustainability practices in lung cancer screening, highlighting use cases from SOLACE and beyond. Lung cancer screening must embed all aspects of sustainability to achieve lasting clinical and social impact.