Financing a national lung cancer prevention and screening program using tobacco tax revenues: a stakeholders' perspective

Purpose This study aims to assess the feasibility and governance of financing a national lung cancer prevention and low-dose CT (LDCT) screening strategy in Brazil's Unified Health System (SUS) using tobacco selective-tax revenues, from a stakeholder perspective. Design/methodology/approach The method of study included a policy-oriented qualitative study combining a structured documentary review (>140 scientific, legal and technical sources selected through explicit inclusion/exclusion criteria), 15 semi-structured interviews with key informants (public health, oncology, regulation, finance and civil society) and a 12-participant multi-stakeholder workshop. Inductive thematic analysis, a triangulation matrix and consensus-oriented deliberation were used to translate evidence into 44 strategic and operational recommendations. Findings Stakeholders converged on three action fronts: (1) strengthen prevention through primary-care-led cessation and youth protection, including enforcement against electronic smoking devices, sustained inflation-indexed tobacco taxation and illicit-trade control; (2) organise an integrated pathway linking risk identification in primary care, LDCT screening, rapid diagnostics, timely treatment and early palliative care, supported by patient navigation and explicit time standards and (3) pilot “soft” earmarking of selective-tax revenues via transparent, results-linked transfers and public dashboards to tie resources to measurable outputs. Research limitations/implications The study involves a single-country qualitative design; recommendations are evidence-informed policy propositions and should be piloted, costed and independently evaluated before national scale-up. Practical implications The study provides an implementable, equity-oriented blueprint (44 recommendations) for SUS and other federative middle-income systems. Social implications The study has the potential to reduce avoidable mortality and territorial inequities while reinforcing tobacco control. Originality/value The study integrates health taxation, federative governance and care-pathway design through a policy-logic frame that links tobacco selective-tax revenues to measurable prevention, screening, diagnostic and accountability outputs without rigid earmarks.