- DZL
- Research
- Clinical Impact
- DZL Academy
- News
- Service
In June 2025, the Federal Joint Committee (G-BA) cleared the way for nationwide lung cancer screening in Germany. Starting in April 2026, statutory health insurance beneficiaries with a long history of heavy smoking will be eligible for low-dose computed tomography (LDCT) as an early detection test. The goal of this new benefit is to diagnose lung cancer significantly earlier and thereby substantially improve treatment outcomes.
This decision marks a milestone in preventive medicine and is strongly rooted in scientific evidence generated in Germany. The HANSE study was one of the key investigations that prompted the G-BA to introduce lung cancer screening as a reimbursable service. The newly published findings build on this foundation and offer important insights for optimizing the national program.
More than 50,000 people in Germany are diagnosed with lung cancer each year. Among women, it is the third most common cancer; among men, the second. Smoking is the primary cause: the longer and more intensely a person has smoked, the higher their risk of developing lung cancer. Because the disease often causes symptoms only at a late stage, it is frequently detected when it has already progressed—resulting in poorer treatment options. Early detection, on the other hand, can significantly improve the chances of successful treatment, including through surgery, immunotherapy, or chemotherapy.
Clinical studies assess the effectiveness of lung cancer screening
Over recent years, international trials have shown that CT-based early detection can help identify lung cancer at an earlier and more treatable stage. A central question, however, is how to identify who truly benefits from screening and how to define high-risk groups as precisely as possible. People at high risk should clearly be offered screening, while those at lower risk should be spared unnecessary CT exposure—also for economic and healthcare resource reasons.
This is where the HANSE study, initiated by the German Center for Lung Research (DZL), comes in. Researchers from the LungenClinic Grosshansdorf, the University Hospital Schleswig-Holstein in Lübeck (both DZL site ARCN), Hannover Medical School (DZL site BREATH), and Charité Berlin together with AstraZeneca, evaluated the feasibility, acceptance, and effectiveness of a nationwide lung cancer screening program.
The team examined how reliably LDCT detects lung cancer when participant selection is based on a comprehensive risk model. They tested the PLCOm2012 score, which incorporates not only age and smoking history but also education level, body weight, the presence of chronic obstructive pulmonary disease (COPD), previous cancer diagnoses, and a family history of lung cancer. For comparison, they used the NELSON criteria, which form the basis of the planned German screening program and rely exclusively on age and tobacco exposure.
All individuals classified as high-risk by either model received two LDCT scans one year apart. Suspicious findings were reviewed in interdisciplinary tumor boards and promptly treated if confirmed.
Broader criteria detect nearly 20 percent more cancer cases
The results are striking: Among roughly 4,200 current or former smokers evaluated with the PLCOm2012 model, 108 lung cancer cases were diagnosed. In the similarly sized NELSON group, 85 cases were found. This corresponds to 19.4 percent more detected cases—while only about 6 percent more individuals needed to be screened.
“If we use the more comprehensive PLCOm2012 score with a defined threshold, we need to screen around 6 percent more people, but we identify significantly more lung cancer cases,” explains Prof. Martin Reck, Head of Oncology at the LungenClinic Grosshansdorf and senior author of the study. “This makes screening more efficient—we need fewer CT examinations per diagnosed lung cancer case.”
Women benefit particularly—current criteria fall short
The findings also indicate that women would benefit disproportionately from the expanded risk model. In the HANSE study, 2.6 percent of women were diagnosed with lung cancer, compared with 1.8 percent of men. Yet many women do not meet the current planned inclusion criteria.
“Many women in our study are active smokers but have smoked fewer cigarettes over their lifetime compared with men, meaning they do not reach the current threshold used in Germany,” says Dr. Sabine Bohnet, Head of the Lung Cancer Center at the Lübeck campus of UKSH and co-author of the study. “They also more often have a family history of lung cancer, a previous cancer diagnosis, or comorbid COPD. We believe these risk factors weigh more heavily for women than for men. Unfortunately, the current criteria do not capture them.”
“Otherwise we miss important risk groups” – researchers call for adjustments
The new national screening program is intended to reduce lung cancer mortality by enabling earlier diagnoses. However, the HANSE findings suggest that the current inclusion criteria may miss relevant risk groups.
“Our study has shown that it is both possible and necessary to revise the eligibility criteria for lung cancer screening based on the HANSE results,” summarizes Prof. Jens Vogel-Claussen, Director of Radiology at Charité and principal investigator of the study. “Otherwise, we risk overlooking important high-risk groups.”
The researchers emphasize that the introduction of LDCT screening is a major step forward in lung cancer prevention. Thanks to the new data, important impulses are now available for further refining the program. The HANSE study not only demonstrates that screening can be effectively implemented in routine care, but also provides key scientific arguments for making the program more precise, gender-sensitive, and efficient in the future.
About the HANSE Study
The HANSE study is an investigator-initiated trial, meaning it was launched independently by the researchers themselves. It compares the NELSON eligibility criteria with a PLCOm2012 risk model that corresponds to a six-year lung cancer risk of at least 1.58 percent. Participants were recruited at the Hannover Medical School (MHH), University Hospital Schleswig-Holstein in Lübeck, and the LungenClinic Grosshansdorf—three lung cancer centers certified by the German Cancer Society (DKG). The study was funded by the DZL and by AstraZeneca as part of the Lung Ambition Alliance. The HANSE study is ongoing: between autumn 2025 and summer 2026, already enrolled high-risk participants will receive an additional CT screening. The team will also, for the first time, investigate whether blood-based biomarkers can be identified that may enable even earlier detection of lung cancer in the future. The overarching goal is to further improve the precision and effectiveness of lung cancer screening.
.
Original publication: Vogel-Claussen J, Bollmann BA, May K, Stiebeler S, Dettmer S, Faron A, Kuhlmann A, Schmid-Bindert G, Kaaks R, Barkhausen J, Bohnet S, Reck M; HANSE investigators. Effectiveness of NELSON versus PLCOm2012 lung cancer screening eligibility criteria in Germany (HANSE): a prospective cohort study. Lancet Oncol. 2025 Nov 10:S1470-2045(25)00490-5. doi: 10.1016/S1470-2045(25)00490-5. Epub ahead of print. PMID: 41232542.
Lungenkrebs-Früherkennung für Raucherinnen und Raucher - Gemeinsamer Bundesausschuss
