Next steps

Alongside the implementation of a National Lung Cancer Screening Program in Australia, there are other important factors that must be considered, such as barriers to accessing screening, the evolving impacts of the COVID-19 pandemic, and the ongoing importance of tobacco control measures and smoking cessation services.

When considering the target population for lung cancer screening, it is clear that screening, at least initially, is likely to only benefit people with a history of heavy smoking. However, many of these individuals may be considered hard to reach due to the stigmatisation of smoking, and the correlation between smoking and socio-economic status, ethnicity, education level, and geographic remoteness. ⁽¹⁾ The concentration of smoking in socio-economically disadvantaged groups means that these individuals typically have less access to health care resources and provision, which may restrict their ability to be able to access a screening program. ⁽¹⁾ Further to this, individuals who live in rural or remote areas also often experience challenges in accessing screening programs, escalated and timely medical investigation, and if necessary, cancer treatment, due to their geographic isolation, and distance from medical services that are at times only available in urban areas. ⁽¹⁾ People have also reported that fear of receiving bad news and the uncertainty of how this may be delivered also acts as a barrier to help-seeking. ⁽²⁾

Stigma remains a prevalent issue across lung cancer control, largely linked to the blame associated with smoking. ⁽¹⁾ This stigma and shame linked to lung cancer and smoking can lead to individuals developing “pessimistic and avoidant beliefs about cancer, contributing to high levels of psychological distress, delays in seeking medical help, and reduced early-detection behaviour.” ⁽¹⁾ The stigma associated with smoking has also resulted in people who smoke reporting hesitation to consult their doctors for symptoms of lung cancer or even unfortunately reporting they deserve lung cancer because they have smoked. ⁽²⁾

Whilst it may be too early to fully understand the impacts of the COVID-19 pandemic on screening services, and on Australia’s ongoing enquiry into the implementation of a National Lung Cancer Screening Program, it is an important consideration that must be monitored, as the pandemic continues to evolve and potentially present new challenges. When a lung cancer screening program is implemented in Australia, this will require the use of LDCT and pathology services, and downstream health services requirements which may have restricted access as a result of the pandemic. ⁽³⁾ Furthermore adequate and streamlined access to the medical system at the point of a screen detected abnormality is paramount to the success of a screening program.

Tobacco control and smoking cessation continue to be a key priority of lung cancer control and as such, must be considered throughout the development of a National Lung Cancer Screening Program in Australia. The United States Preventive Services Taskforce (USPSTF) recommends that smoking cessation interventions be offered to all individuals enrolled in a lung cancer screening program who continue to smoke. ⁽⁴⁾ Similarly, the Cancer Australia enquiry has recommended that if a National Program was to be introduced, those who continue to smoke be referred to existing quit services such as Quitline. ⁽⁵⁾ This program will require expansion and further specialisation at the point of a National Lung Cancer Screening Program going live.