09 July 2025
Detecting lung cancer earlier through targeted screening — and thereby improving chances of survival — is the goal of the ZORALCS study, currently underway in six municipalities around Antwerp. People between the ages of 55 and 74 who smoke or used to smoke are being offered a free CT scan. “More than 350 people have already scheduled an appointment for a scan,” says Prof. Dr. Annemiek Snoeckx.
“Lung cancer is the second most common cancer in our country, and the deadliest. That’s because symptoms usually appear only at a late stage, when the cancer has already spread and survival rates are low.”
Dr. Annemiek Snoeckx is an associate professor at the University of Antwerp, head of radiology at Antwerp University Hospital (UZA), and lead investigator of the ZORALCS study.
In recent years, she explains, research has shown that early detection of lung cancer using low-dose CT scans in high-risk individuals can significantly reduce the risk of death from the disease.
“This strong scientific evidence now needs to be translated into clinical practice and integrated into our healthcare system. To do that, we need implementation research — a goal supported by both the EU and Flanders — and that’s exactly what we’re doing with ZORALCS.”
The study’s name is derived from the ZORA primary care area (Southeast Antwerp Area), and the research is taking place in the municipalities within that zone: Boechout, Kontich, Lint, Mortsel, Edegem, and Hove.
“Our biggest challenge is identifying all high-risk individuals — people who have smoked for many years or did so for a long time,” says Dr. Snoeckx. “That kind of information isn’t always readily available in patient records, so we need other ways to reach them. One way we’re doing that is through an online platform where potentially eligible participants answer a short set of questions.”
To estimate someone’s likelihood of developing lung cancer based on current or past heavy smoking, ZORALCS uses a risk prediction model. “It considers pack-year smoking history but also factors like family history, any diagnosis of COPD, BMI, education level, and more.”
“To gather that information, participants fill out a brief questionnaire on our secure online platform, which is protected using itsme. They receive immediate feedback on whether it’s recommended they schedule a CT scan.”
Visiting a website, logging in with itsme, answering questions—how accessible is that for everyone? “It’s a barrier, but one we can’t avoid for privacy reasons,” Dr. Snoeckx acknowledges.
“We recommend that people who are less comfortable with digital tools ask their children or grandchildren for help. Our invitation letters also include information about local digital assistance centers in each municipality, where people can get in-person help.”
“To reach as many people as possible, we’re also collaborating with primary care providers, pharmacists, other healthcare professionals, municipal governments, social service agencies, senior councils, and local organizations. We’re also running campaigns on social media.”
‘GPs, pharmacists, physical therapists, and home care nurses are all close to their patients. We need all of them to ensure we reach everyone’
But with primary care already overstretched, is it realistic to expect GPs to play a role?
“We’re not asking them to conduct the screening or fill out any forms. All we ask is that they inform their patients—let them know that this free screening is available, and if someone smokes or used to smoke heavily, give them a gentle nudge to visit our online platform. GPs, pharmacists, physical therapists, and home care nurses are all close to their patients. We need all of them to ensure we reach everyone.”
In three of the six municipalities, invitation letters have already been sent with more than 10,000 people have been invited to take the online test. Dr. Snoeckx: “More than 350 people have already made appointments for scans. Overall, recruitment is going well. It’s hard to say exactly what percentage of high-risk individuals we’re reaching because we don’t know the exact size of that population.”
‘We’re reaching a large group of people with lower educational attainment — something that’s often harder to achieve in studies like this.’
“What’s encouraging is that nearly half of respondents indicate that high school was their highest level of education. That means we’re also reaching a large group of people with lower educational attainment — something that’s often harder to achieve in studies like this.”
In Flanders, population screening invitations are legally required to be in Dutch, but QR codes let recipients access the information in other languages. “We’re also exploring ways to run more targeted campaigns for different cultural communities.”
The CT scans are performed at UZA on Saturdays — about 30 per week. “A dedicated team is present for the lung cancer screenings,” says Dr. Snoeckx. “Everything runs smoothly. At the same time, we’re also conducting a smoking cessation study called TAMIRO-STOP. Eighty percent of smokers participating in ZORALCS are also taking part in this program.”
“TAMIRO-STOP is evaluating the added value of intensive smoking cessation support. Participants are divided into two groups: one receives structured support from a tobacco counselor, while the other receives only brief information about available resources.”
“I hope the study will show that offering intensive help at the time of screening significantly increases the chance of success. Combining screening with support also adds substantial value from a cost-effectiveness standpoint.”
It’s still too early to say how many lung tumors have been found through ZORALCS. “But we’ve already identified a number of very suspicious abnormalities,” says Dr. Snoeckx.
“Is this kind of screening cost-effective? Absolutely. Belgium’s Health Care Knowledge Center (KCE) studied the issue in detail and published its findings last year. Even compared to other cancer screening programs, this one is cost-effective — thanks to the risk prediction model and the targeted population.”
“Of course, there’s still the cost of the CT scan, the AI analysis, and the radiologist’s time. But the group we’re screening is relatively small — much smaller than, say, for breast cancer screening.”
The CT scans are reviewed by both an AI algorithm and a radiologist. “Both systems detect nodules,” explains Dr. Snoeckx. “It’s more cost-effective than having two radiologists, and the algorithms perform extremely well when paired with a radiologist’s expertise.”
“Some nodules with unusual shapes or structures might be missed by the algorithm but caught by the radiologist — so we’ll never fully rely on technology alone. Currently, the radiologist reads the scan first, then the AI. In the future, it may be the other way around.”
‘Currently, the radiologist reads the scan first, then the AI. In the future, it may be the other way around.’
“If a scan shows something that could indicate lung cancer, the patient’s GP is notified electronically first, followed by a letter to the patient. We also follow up with a phone call to the doctor.”
Dr. Snoeckx emphasizes that the biggest health benefits of preventive screening occur at the population level rather than the individual level. “This approach is effective and cost-efficient — something that can’t be said for one-off screenings.”
The study started in March 2025, and the first round of screenings will continue through February of next year. “Everyone who gets a scan will be invited back for a follow-up scan one year later. Whether the study continues or is expanded will depend on the government.”
“Compared to the rest of Europe, I can confidently say our approach to lung cancer screening is cutting-edge. The use of a risk prediction model, the active involvement of primary care providers in outreach, the parallel smoking cessation program, and our digital platform—that combination is quite unique.”
Many women with gynecological cancer feel alone and ashamed. Gynca's wants to change that. The non-profit organization gives them a voice and stands up for their interests. Chair Anne De Middelaer looks back on the past five years — and ahead to the future. “There is still a lot of…
The last structured Cancer Plan was introduced in 2008, at a time when there was still no coordinated policy framework for cancer care. In 2025, the question is whether a completely new Cancer Plan is truly necessary. What seems to be needed instead is a process of renewal and reflection.
2024 was a remarkable year for All.Can Belgium in many ways. Our actions attracted considerable attention, particularly from policymakers. In this annual report, we’ve brought everything together for you.
