Stakeholders Back Lung Cancer Screening in Flanders, but Warn Stigma and Capacity Gaps Could Undermine It

Low-dose computed tomography (LDCT) screening has repeatedly shown that it can catch lung cancer earlier and reduce death rates in people at high risk, yet Belgium has so far stopped short of launching a population-based programme. Researchers interviewed 22 healthcare professionals involved in lung cancer prevention, detection or care, alongside 13 potential screening participants who would likely be eligible if such a programme were introduced, and mapped their views onto an established implementation science framework. The interviews, conducted between October 2024 and February 2025, were analysed using the Qualitative Analysis Guide of Leuven, a structured qualitative method, and the resulting themes were then organised according to the Consolidated Framework for Implementation Research, a widely used model for understanding what helps or hinders the rollout of health interventions.

This dual approach allowed the team to move beyond anecdote and anchor stakeholder concerns in a framework that policymakers and programme designers elsewhere can also apply. The headline finding is one of cautious optimism. Attitudes towards lung cancer screening were broadly positive across both stakeholder groups, driven by two powerful motivations: the perceived benefit of catching disease early, and the reassurance that a clean scan can provide.

But the study is equally clear about the obstacles. Participants and professionals alike worried that stigma could deter exactly the people a screening programme most needs to reach, including current and former smokers who may already feel blamed for their illness. Limited health literacy compounded the problem, as did indirect financial and logistical constraints, competing life priorities, and fear or anxiety about the screening process itself and the waiting period for results.

These barriers are not evenly distributed, and that is precisely what concerns the researchers. The study frames its findings around equitable participation, noting that people with lower health literacy, tighter budgets or less flexible working lives face systematically higher hurdles to attending a scan and following up on results. Healthcare professionals added a second layer of concern that participants themselves were less likely to raise: the practical capacity of the system to absorb a new screening programme.

Interviewed clinicians flagged workload pressures, limited existing capacity, and the need for professional training so that staff across prevention, primary care and secondary care can play their part. They also emphasised the importance of coordinated communication pathways, so that invitations, results and follow-up referrals move smoothly between the different professionals a participant will encounter along the screening journey. Against these barriers, the interviews surfaced a concrete set of facilitators that stakeholders believe would make implementation workable.

Clear and standardised screening guidelines ranked high, as did governmental coordination and funding, which stakeholders saw as essential for giving a programme legitimacy and stability. Integration within existing healthcare workflows was identified as a way to reduce the burden on both professionals and participants, while an accessible and flexible screening organisation, for example accommodating people who cannot easily attend during standard working hours, was viewed as critical for reaching underserved groups. Communication emerged as a thread running through nearly every theme.

Public awareness campaigns were seen as necessary to build understanding of who is eligible and why screening matters, but stakeholders stressed that the tone of that communication matters as much as its reach. Across both groups, trust-based, non-judgemental communication was considered essential, and endorsement by trusted healthcare professionals was viewed as one of the most powerful levers for encouraging participation and sustaining engagement over time. The study's authors conclude that stakeholders in Flanders are broadly supportive of population-based lung cancer screening, but that successful implementation will depend on addressing organisational complexity, stigma, equity and accessibility head-on.

Beyond the clinical efficacy already demonstrated for LDCT, they argue that careful programme design, interprofessional collaboration and person-centred communication will determine whether uptake is equitable and sustainable rather than concentrated among those who face the fewest barriers. The findings are framed as actionable guidance for Belgian policymakers, and the authors suggest they may also inform implementation in comparable healthcare settings and systems elsewhere in Europe. As with any qualitative study, the scope of the conclusions has limits.

The findings reflect the perspectives of 35 stakeholders in one region during a pre-implementation period, and they describe perceived barriers and facilitators rather than measured participation rates or mortality outcomes, which can only come from an actual screening programme. For Flanders, the message is that the will to screen exists on both sides of the consultation table; the task now is to design a programme that does not leave the most vulnerable behind.

Subject of Research: Qualitative stakeholder analysis of barriers and facilitators to implementing population-based LDCT lung cancer screening in Flanders, Belgium

Article Title: Barriers and facilitators to population-based lung cancer screening in Belgium: a qualitative stakeholder analysis in a pre-implementation context

Article References: Michiels, L., Duchateau, J., Vangilbergen, A., Verlies, C., Dooms, C., Van Hal, G., & Huys, I. (2026). Barriers and facilitators to population-based lung cancer screening in Belgium: a qualitative stakeholder analysis in a pre-implementation context. BMC Health Services Research, 26(1), Article 1272. https://doi.org/10.1186/s12913-026-15349-6

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15349-6

Keywords: lung cancer screening, low-dose computed tomography, Flanders, Belgium, qualitative research, implementation science, CFIR, smoking stigma, health literacy, health equity, healthcare professionals, screening uptake