Germany has officially entered structured lung cancer screening. As of 1 April 2026, low-dose CT (LDCT) screening became a statutory benefit under the national health insurance system, backed by a G-BA decision of June 2025 and the Federal Environment Ministry's lung cancer screening ordinance, which entered into force in July 2024.
The launch marks one of Europe's most consequential statutory LDCT rollouts to date. The program targets a clearly defined high-risk population: individuals ages 50 to 75 with a smoking history of at least 25 years and at least 15 pack-years, who are either current smokers or have quit within the past 10 years.
Annual LDCT is reimbursed extrabudgetarily, with the first reading, including patient information and documentation, billing at €95.04, and the independent second reading for controllable or suspicious findings at €49.56.
Evidence supports the intervention
The stakes are significant. Lung cancer remains Germany's deadliest malignancy, accounting for 58,300 new diagnoses in 2023 and approximately 45,000 deaths annually. It causes 21.6% of cancer deaths in men and 17.3% in women. Only around 15% of cases are caught at Stage I, while more than half present at Stage IV, when treatment options are severely limited.
The HANSE study, published in Lancet Oncology in November 2025, found that the PLCOm2012 risk model identified around 19.4% more cases than NELSON-based criteria, screening approximately 6% more people in the process, raising questions about whether Germany's current eligibility thresholds already need broadening, particularly to capture more women.
Policy into Practice
"If you want to get this off the ground, coordinate locally with the cooperation partners that are necessary anyway, and set it up together. BDR and DRG are moving forward on this jointly," said Prof. Dr. Hermann Helmberger, BDR president.Courtesy of Claudia Tschabuschnig
Despite the formal launch, translating policy into practice has proven complex. Speaking at a RÖKÖ Digital session on 4 May, Berufsverband der Deutschen Radiologen (BDR) president Prof. Dr. Hermann Helmberger called on radiologists to organize locally rather than wait for top-down solutions.
"If you want to get this off the ground, try to coordinate locally with the cooperation partners that are necessary anyway, and set it up together," he said. "BDR and DRG are moving forward on this jointly."
A key unresolved tension is infrastructure funding. Markus Henkel, BDR managing director and legal counsel, noted that health insurers are refusing to reimburse the digital platform infrastructure required to manage double-reading workflows across sites.
"The health insurance providers have said: a platform like this is not provided for in the guidelines, and if it is not provided for, it will not be paid for," he said.
The G-BA acknowledged the complexity at the program's approval, with board member Bernhard van Treeck, MD, noting that strict quality assurance requirements are in place, including special qualifications for participating radiologists and mandatory second interpretation of flagged findings, and that false positives and overdiagnosis remain real risks to manage.
Gap in digital referral infrastructure
"The health insurance providers have said: a platform like this is not provided for in the guidelines, and if it is not provided for, it will not be paid for," noted Markus Henkel, BDR managing director and legal counsel.Courtesy of Claudia Tschabuschnig
Henkel also flagged a gap in digital referral infrastructure: insurers have suggested that large imaging files could be routed via KIM, Germany's secure medical messaging system, which now supports attachments of up to 500 megabytes.
"In practice, we consider that not fit for purpose," Henkel said, "but in theory it is conceivable." Until RIS vendors implement proper digital referral workflows, practices risk being left managing patient handoffs manually between first and second readers operating different systems, including AI tools from different vendors that may not process prior imaging acquired under nonstandard protocols.
Regional cooperation models are beginning to emerge as a practical response. In Germany's Bremen, the state radiology association is coordinating three lung centers with all regional radiologists, a structure that Helmberger and Dr. med. Klaus Hamm, longstanding BDR board member, highlighted at RöKo Digital as a replicable template, noting that consolidating network connections reduced IT overhead significantly for participating hospitals.
"The state association in Bremen is currently organizing the collaboration of three lung centers with all radiologists in the region, which can lead to significant cost advantages," noted Dr. med. Klaus Hamm, longstanding BDR board member.Courtesy of Claudia Tschabuschnig
The BDR has also published a model cooperation contract, a radiation protection directive, and quality management implementation materials for members, available on the BDR website.
On the technology side, South Korea-based Coreline Soft has launched a Germany-specific AI platform in response to the new requirements. Its Aview HUB system manages multisite workflows, second reading, and consensus processes, pairing with Aview LCS Plus for nodule detection.
The company will demonstrate the platform at RÖKÖ Leipzig, taking place 13 to 15 May in Leipzig, where lung cancer screening is expected to be examined jointly across radiology, pneumology, and thoracic surgery.
