Policy priorities

Develop and implement a sustainable, evidence-based targeted risk-based National Lung Cancer Screening Program in Australia in a timely manner, accounting for lessons learnt from existing National Screening Programs in Australia.

As Australia’s biggest cancer killer, implementation of a National Lung Cancer Screening Program (the Program) will support the reduction of the cancer mortality burden in Australian communities. It is estimated that ~78% of lung cancer cases are attributable to smoking. ⁽¹⁾ To date, large randomised controlled trials have demonstrated that lung cancer screening is beneficial for individuals with a history of heavy smoking. Therefore, to maximise the benefits, and minimise harms of the Program, it is important that it be targeted to those most at risk of developing lung cancer. Evidence is evolving to qualify risk factors beyond smoking, but high-level practice changing data is yet to qualify additional risk factors for incorporation into a screening program.

The number of new cases of lung cancer is increasing, largely due to Australia’s ageing population and improved access to the medical system and diagnostic pathways, which allow more cases to be detected. It is estimated that between 2021 and 2040, about 196,000 people will die from lung cancer, ⁽²⁾ and the majority of these cases will be diagnosed at late incurable stage, with just 11.7% of people diagnosed with lung cancer at Stage 1. ⁽³⁾

Cancer Council Australia is supportive of both Cancer Australia and the Medical Services Advisory Committee’s (MSAC) recommendations that lung cancer screening be offered to older individuals with a history of substantial smoking, who are considered to be high risk for developing lung cancer. Cancer Council is supportive of the Program being revised over time in response to new evidence on the balance of benefits, harms, and cost-effectiveness of screening, particularly with respect to eligibility criteria. For more specific information on these recommendations, see the policy context and impact page of this chapter.

Embed evidence-based tobacco dependence treatment within the National Lung Cancer Screening Program, and ensure it is offered to every tobacco user in every interaction with the health system, whilst minimising the potential for stigma.

Implementing comprehensive and integrated treatment guidelines to promote cessation of tobacco use and adequate treatment for tobacco dependence is needed in Australia to meet our obligations under Article 14 of the Framework Convention of Tobacco Control (FCTC).

Cancer Australia’s report on the Lung Cancer Screening enquiry recommended that when a National Lung Cancer Screening Program is introduced, that all individuals who are eligible for participating in the Program, and currently smoke, be offered access to existing smoking cessation services outside the Program, such as Quitline. ⁽⁴⁾ Cancer Council recommends that all individuals who smoke who are assessed for lung cancer screening, must be offered access to smoking cessation services, regardless of whether they are deemed eligible for participating in the Program.

Cancer Council therefore recommends that evidence-based tobacco dependence treatment be embedded both within the development of a National Lung Cancer Screening Program, and as part of routine care in all health, mental health, and drug and alcohol services in Australia. For more information on Cancer Council’s recommendations on tobacco dependence treatment options, see the Tobacco Control policy priorities.

Ensure that the National Lung Cancer Screening Program is culturally safe and is acceptable and accessible to Aboriginal and Torres Strait Islander peoples, culturally and linguistically diverse communities, individuals in lower socio-economic groups, and those living in rural and remote communities.

Aboriginal and Torres Strait Islander peoples, Australians living in remote, very remote areas, and communities of greatest socioeconomic disadvantage, are disproportionately affected by lung cancer, with higher lung cancer incidence and mortality in these groups. Aboriginal and Torres Strait Islander peoples are twice as likely to be diagnosed with lung cancer than non-Indigenous Australians. ⁽³⁾ Further to this, individuals living in regional, rural, and remote areas of Australia, have a lower five-year relative survival rate than those living in major cities (18.9% for people living in a major city vs 12.7% for people living in remote and very remote areas). ⁽³⁾ It is imperative that the development of a National Lung Cancer Screening Program is culturally safe, sensitive, accessible, and acceptable to the needs of the population sub-groups who are most affected by lung cancer.

Cancer Council recommends ongoing appropriate consultation with Aboriginal and Torres Strait Islander peoples throughout the development and implementation of the Program, to ensure that communities needs are met, and the Program can be effectively delivered in a culturally safe way. Cancer Council also recommends that the Program is guided by culturally appropriate service delivery, resources, and messaging to engage with culturally and linguistically diverse communities. Finally, the National Lung Cancer Screening Program must provide engagement and access to the Program for those living in remote or very remote areas, who often face barriers and challenges in accessing screening programs and treatment, as a result of their geographic isolation, and the availability of health services clustered in urban areas. ⁽⁵⁾ Potential examples include the use of mobile CT scanners, and telehealth appointments.