The Lung Cancer Screening program
Announcement by the Minister for Health and Aged Care
On 2 May 2023, the Minister for Health and Aged Care announced $263.8 million over four years for a National Lung Cancer Screening Program (LCSP). TOGA welcomed the news as this program will facilitate detection of lung cancer at an earlier stage, significantly improving chances of survival.
Why focus on lung cancer?
The number of new cases of lung cancer diagnosed in Australia is continuing to rise each year, with an estimated 14,272 cases diagnosed in 2023; an increase from 13,078 new cases diagnosed in 2018. Lung cancer is the 5th most common cancer but continues to be the leading cause of cancer death in Australia with over 8000 deaths per annum.
Indigenous Australians are twice as likely to be diagnosed and die from lung cancer compared to non-Indigenous Australians. Statistics gathered by Cancer Australia demonstrate that lung cancer not only accounts for the highest proportion of cancer diagnoses in this population but is also the highest cause of mortality, almost 5-fold compared to the second biggest cause of cancer mortality – colorectal cancer.
Why is early detection important?
While survival rates for people with lung cancer are improving, they remain low as most lung cancer diagnoses occur in the advanced stage of the disease, where survival rates are poor. The five-year relative survival for stage IV lung cancer is 3.8%, compared to 67.7% for stage I lung cancer. To overcome this striking disparity, lung cancer needs to be diagnosed and treated at earlier stages of disease, when curative treatment is possible.
Two large clinical trials (NELSON and ILST) have provided evidence that early detection via low-dose CT (LDCT) imaging in high-risk populations reduces the number of deaths from lung cancer, highlighting the need for developing such a program to improve lung cancer outcomes in Australia.
How was the lung cancer screening program developed?
Cancer Australia published a report on the Lung Cancer Screening Enquiry (LCSE) in October 2020. Since July 2021, Cancer Australia, in partnership with the Department of Health and Aged Care, has led the early design and feasibility assessment of a potential national LCSP. A comprehensive stakeholder engagement and consultation strategy was developed (see Figure 3 – sourced from Cancer Australia’s summary report), with a particular emphasis on consulting with Aboriginal and Torres Strait Islander representatives to ensure the unique needs of Indigenous Australians were considered in the early design of a potential LCSP. This was achieved through consultation with Aboriginal Health Workers and Practitioners/coordinators, Tackling Indigenous Smoking coordinators, Aboriginal liaison officers and cancer care coordinators, researchers, policymakers and consumers.
During the development process Cancer Australia received independent advice from MSAC supporting the introduction of a national LCSP, including the creation of a new Medicare Benefits Schedule item for LDCT scans, to support the early detection of lung cancer in asymptomatic high-risk individuals.
How does the lung cancer screening program work?
The primary aim of the lung cancer screening program (LCSP) is to reduce the mortality and morbidity associated with lung cancer as well as support smoking cessation at all stages of the screening and assessment pathway. The effective integration of smoking cessation into a LCSP is essential. The maximum reduction in mortality is achieved with a combination of smoking abstinence and LDCT screening.
The proposed LCSP will offer screening to high-risk candidates: Australians over 50 years who currently smoke or who have previously smoked and meet internationally validated risk assessment criteria. Participants will be eligible for screening until they are 70 years old. A participant can access the LCSP via self-referral through a primary health care professional or can arrange a referral and assessment via a primary care provider of their choice. Mobile options for LDCT scans will also be available, extending reach into areas of Australia where radiology services are not easily accessed.
Participants will be treated according to the scan outcome as follows:
- No significant findings: Recommended to return for screening every two years.
- Low malignancy risk: Recommended to return in 12 months.
- Participants with moderate malignancy risk: Recommended to return in three months.
- High-risk findings or suspicion of lung cancer: Rapid referral to a specialist linked to a multidisciplinary team for clinical assessment and follow up.
When will the screening program begin?
The program will commence screening by July 2025. More information on the LCSP can be found on the Cancer Australia Website
Source for figures 1 and 2 can be found here