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Lung cancer screening - the bigger picture

Lung cancer screening - the bigger picture

Monday, January 08, 2024

Happy New Year. It’s time to celebrate everything we achieved in 2023 and look forward to all that 2024 brings. Then make a wish – and a resolution.

Associate Professor Emily Stone’s wish this year, as always, is for a cure for lung cancer. Her resolution for 2024 is that the $263.8 million of government funding announced last year for the implementation of a national lung cancer screening programme saves as many lives as possible.

The programme, scheduled to commence in July 2025 is being co-designed with the First Nations health sector and aims to maximise prevention and early detection of lung cancer amongst high-risk population groups.

Associate Professor Stone is a member of the Lung Cancer Research Network, a multidisciplinary group of more than 20 research teams who come together at the Woolcock's Centre for Lung Cancer Research. At its Lung Cancer Symposium in November, researchers raised the inequity of treatment and outcomes for lung cancer patients in rural, regional and high-risk populations as a major challenge.

Associate Professor Stone is the NSW primary investigator for the International Lung Screen Trial (ILST) of low-dose CT screening for lung cancer in Australia and internationally. She also edits the Journal of Thoracic Oncology Clinical and Research Reports, one of the flagship journals for the International Association for the Study of Lung Cancer.

So she “nearly flipped” with excitement when the news of funding for lung cancer screening in Australia was announced in May 2023.  

The evidence is clear – lung cancer screening saves lives and provides a net financial benefit to the health system – if it is targeted and implemented properly.

Associate Professor Stone says it's vital that we get the programme right and the way to do that is to learn from screening trials and studies that have been running in the United States, United Kingdom and Canada.

“Screening uptake is critical,” she says. “If nobody does it, then it’s a waste of everybody’s time and money and effort. And, if we only screen the people who don’t really need it – the motivated, healthy, well-resourced in inner-metropolitan centres – and we overlook the remote, regional, high-smoking lung cancer populations and, in particular, First Nations peoples, then we’ll miss out on helping people who most stand to benefit.”

She says the uptake for the US screening programme which started in 2013 has been “worryingly low”. Data from 2021 shows that the best-performing centres there are getting at best a quarter of eligible people going through to a CT scan while the national average is around five percent. On the flip side, the pilot screening programme being run in the UK has seen 56 percent of those invited to participate take up the offer and 97 percent of those recommended for a CT scan doing so.

“Scanning in the UK is embedded in a Lung Health Check programme which is nice to patients. It has things like lung cancer nurses, engages in lung cancer support, spirometry, detection and treatment of COPD (Chronic Obstructive Pulmonary Disorder). Plus the communications to patients after their scan include recommendations around smoking, COPD management and incidental findings from the scans, not just a black and white statement regarding evidence of lung cancer. That’s important and food for thought for our programme because the MSAC (Medical Service Advisory Committee) recommendation to the government was for funding the CT scan only and not all the things that go around it which are vital to the programme’s success.”

While Associate Professor Stone is concerned about the implementation of screening in the United States, she says they have good ideas when it comes to co-design, including clinicians with expertise in the management of lung disease, eligibility criteria and virtual multidisciplinary teams to support regional populations that Australian researchers and clinicians can learn from.

And there are also fantastic lessons to take from Canada where lung cancer outcomes are the best in the world, with regard to integrated software packages that accept referrals and generate results for primary care providers as well as navigators to help participants engage with the screening programme. 

Lots of great work was done during 2023 on the planning and design of the Australian programme. This will continue this year concentrating on how to best integrate smoking cessation into screening, how to best connect with First Nations communities, how to run the programme in rural communities where there can be very high rates of smoking and how to prepare the primary care workforce.

Associate Professor Stone's resolution is that, when lung cancer screening does roll out in Australia, we've done everything possible to get it right. Lives depend on it.  

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