Introduction: The first pilot lung cancer screening (LCS) in Serbia started in October 2020. During 2 years, LCS faced challenges that needed to be overcome to improve and increase the number of responders. 

Aims and objectives: To present the 2-year results and challenges in implementing LCS.

Methods: Persons aged 50-74 years, with a smoking history of 30 pack-years or more or 20 pack-years with additional risks (COPD, prior pneumonia, other malignancy, LC hereditary history or exposure to environmental carcinogens) undergone LDCT evaluation. Radiological assessment and further evaluation were done per Lung RADS score. 

Results: During a 2-year period, a total of 3432 LDCT scans were performed on 2138 screen responders. The majority were females (58.1%). Females, compared to males, were often active smokers (87.1% vs. 78.7%, p<0.001) and frequently reported respiratory symptoms (72.1% vs. 65.5%, p=0.01).

Lung RADS score positive results were found in 9.3%.

The response rate to control LDCT after 12 months was 76.5% (786/1027). 

The invasive diagnostic was performed in 2.3% of participants, while 0.5% refused invasive procedures. 

The LC detection rate was 1.8%, and 70.0% (28/40) were diagnosed on baseline screening. 57.5% (23/40) of LC were in I and II stages. LC detected during follow-up were often in stage I compared to baseline (75% vs. 32.1%, p=0.01).

Among LC, 88.1% were NCSLC (adenocarcinoma 54.8%, squamous 21.4% and NOS 9.5%), and 11.9% were SCLC. LC was more common in males than females (1.7% vs. 0.9%, p=0.04). 

Conclusion: Above 50% of LC were in stage I and II. Innovative approaches, education and a more recognizable campaign are necessary to increase the response rate among responders with negative baseline LDCT.