Germany’s national screening programme

Germany makes lung cancer screening a reality

Germany has long prioritised prevention and health promotion; this is reflected in the Prevention Act, which came into force in 2015 and aims to promote health and prevention for people of all age groups.¹ Building on this commitment, the country launched a national low-dose computed tomography (LDCT) screening programme for lung cancer on 1 April 2026, fully financed by the public health insurance system.²

Before the roll-out of Germany’s programme, only three European countries – Croatia, England and Poland – had national LDCT lung cancer screening programmes (please refer to the Network’s interactive map of lung cancer screening for the latest updates).³ So Germany’s launch represents important progress for lung cancer prevention in Europe, where implementation has lagged behind the evidence and political commitment has often been limited.³

Despite slow uptake, Europe has made significant progress on lung cancer screening in recent years, with growing political commitment reflected in Europe’s Beating Cancer Plan, European Union (EU) Council recommendations, the fifth edition of the European Code Against Cancer and other EU-funded initiatives.^4-7 The challenge now is to translate this momentum into screening programmes that are high quality, equitable, scalable and sustainable.

Collaboration and commitment paved the way

In Germany, a coalition of professional societies focused on radiology, pulmonology and thoracic surgery (Deutsche Röntgengesellschaft, Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, and Deutsche Gesellschaft für Thoraxchirurgie), consistently advocated for the introduction of lung cancer screening and published supporting guidelines and position statements.

A major milestone came in 2024 with the publication of a joint position paper that called for the introduction of screening, summarised the evidence base and set out the steps needed for structured, quality-assured implementation.⁸ The paper also provided practical recommendations on screening processes and stakeholder roles.⁸

That same year, the Federal Ministry for the Environment, Climate Action, Nature Conservation and Nuclear Safety approved the use of ionising radiation for lung cancer screening in healthy people, establishing the programme’s radiation protection and technical requirements.⁹

In 2025 and 2026, the Federal Joint Committee (Gemeinsamer Bundesausschuss or G-BA), Germany’s highest decision-making body for statutory healthcare, made decisions on the reimbursement and implementation of the programme in the public health system.²

The programme in practice

People at high risk of lung cancer are assessed by primary care providers, internists or occupational health physicians, who provide potential screening participants with information on the benefits and risks of LDCT for lung cancer screening.¹⁰

People meeting the following criteria are referred for screening:¹⁰

• aged 50 to 75 years, and
• either currently or previously smoked and have done so for 25 years, including 15 years of smoking an average of 20 cigarettes a day.

Any smoking break must not have exceeded 10 years.

Once enrolled, people will undergo the following steps, depending on the findings:¹⁰

• An LDCT scan is conducted and analysed.
• If the findings are normal after the first examiner, a radiologist* (supported by AI-assisted detection) assesses the LDCT scan and the person is invited for another scan after 12 months.
• If the first examination shows findings that require a follow-up, the LDCT scan is independently reviewed by a second examiner. Both radiologists assess the scan and determine whether further investigation is needed.
  • If an abnormality is identified, but is considered most likely benign, the radiologists will recommend a follow‑up scan within the next year to monitor any changes.
  • If the radiologists identify signs that may indicate lung cancer, the person is contacted urgently to arrange further tests.

Innovating for accuracy and efficiency

The German programme stands out for its integration of AI-assisted detection as part of its quality assurance approach, with potential benefits for both screening participants and healthcare professionals:^{12 13}

• Computer-aided detection enhances accuracy by identifying subtle abnormalities that might otherwise be missed. It also reduces false positives, helping to avoid unnecessary follow‑up procedures.
• Efficiency is improved by automating time‑consuming tasks such as image measurement and analysis, allowing radiologists to focus on more complex decisions.
• Information is provided to the first and second readers, which helps reduce variation between assessments and removes the need for two radiologists to review each scan unless a scan requires specific follow-up; it also helps ensure reliable results across very large volumes of scans.¹⁴

Embedding safety from the outset

In Germany, decisions on the use of ionising radiation in screening begin with an assessment by the Federal Office for Radiation Protection (Bundesamt für Strahlenschutz).¹⁵ Recognising that high-quality LDCT screening programmes depend on robust safeguards – with radiation protection a central consideration – this approach brings radiation protection authorities into the process from the outset and supports the development of clear technical standards.¹⁶ The country’s rigorous assessment of radiation-related risks and benefits offers a useful example for other countries planning or evaluating screening programmes.

Compared to the US and other countries, the radiation dose threshold in Germany is significantly lower, matching levels seen in more recent screening programmes (e.g. UK, Croatia) and reflecting technological progress since the inception of lung cancer screening.¹⁷ Additionally, clear guidelines for conducting LDCT scans for lung cancer are available, including established radiation control mechanisms such as automatically adapting scan parameters to the individual patient.¹⁷

Building on success: next steps for the programme

Germany’s programme is emerging as an important example of best-practice early detection. However, as the programme is still in its early stages, further refinements will be needed in the coming years.

A key opportunity is to transition lung cancer screening from a programme regulated under Section 25 of social security law to one regulated under Section 25a. These are the two mechanisms through which regulated screening can be implemented in Germany.^{18 19} Section 25a governs organised screening programmes with formal invitations, regular monitoring and outcome evaluation, while Section 25 relates to health checks without a structured invitation system.¹⁴ Currently, lung cancer screening in Germany is regulated under Section 25, in contrast to programmes such as mammography screening, which operate under Section 25a.⁸

As a result, identifying and referring eligible people relies heavily on primary care providers, rather than a systematic invitation process.¹⁴ Recognising this limitation, and drawing on evidence from the UK linking organised screening with reductions in lung cancer mortality, German professional societies have strongly advocated for lung cancer screening to transition to a Section 25a programme.⁸ Political bodies see the EU guideline on lung cancer screening as a prerequisite for this change.

Alongside this longer-term policy opportunity, several implementation challenges will need to be addressed:

• The programme’s set-up is complex and bureaucratic, requiring CT scanner certification, specialised training and coordination among referrers, radiologists and second readers.21 While feasible, bringing all these elements together locally is likely to slow the pace of implementation.¹⁴
• Successful roll-out depends heavily on primary care providers identifying and referring eligible people, given the absence of a formal invitation system.¹⁴
• Infrastructure and implementation challenges associated with Germany’s decentralised health system will also need to be addressed, as responsibilities are distributed across multiple organisations and stakeholders.²⁰ Different regions rely on different bodies for approval and certification, meaning some have already begun implementation while others remain delayed by administrative processes.²¹

*Only certified radiologists with specialist training and experience (at least 200 chest CT scans in the year prior to screening, 100 screenings in the first year and 200 screenings annually thereafter) can conduct and analyse LDCT scans.¹¹