Australia lags behind other countries in research towards implementing targeted lung cancer screening, even though there are 2.2 million former smokers who may be eligible, argue experts in an article published in the Medical Journal of Australia.
Dr Fraser Brims, a consultant physician at the Sir Charles Gairdner Hospital in Perth, and his coauthors write that lung cancer is the fourth leading cause of death, and kills more Australians than colon cancer and breast cancer combined.
“Primary prevention remains crucial and will reduce future lung cancer deaths, but the majority of lung cancer deaths are now occurring in former smokers who remain at elevated lifetime risk of lung cancer”, the authors note.
Screening with low-dose chest computed tomography (CT) has been shown to reduce lung cancer mortality by at least 20%, and is now being implemented in the United States, they wrote.
When combined with initiatives to stop smoking, standardised selection and management of screening participants, and specialist multidisciplinary teams who assist those with positive results, targeted screening is cost-effective.
“The costs of treating advanced lung cancer are greater than the costs of treating the early stage disease”, Brims and his colleagues wrote.
“Further, a consequence of rising pharmaceutical costs of cancer treatment is that early detection becomes more desirable both in direct mortality reduction and reduction of downstream treatment costs.”
Implementation of targeted screening in Australia was being hampered by the lack of some “vital information”, including “an economic evaluation to assess health care cost utility; definition of a target population; false-positive rates; and best recruitment and uptake strategies”, they wrote.
“Lung cancer screening would screen participants who have been individually assessed as having a higher than average risk”, commented the authors.
“A national program needs to be community based with shared, informed decision-making between clinicians and potential participants, accredited reporting centres and a central data registry for quality control, monitoring and outcome reporting.
“Crucially, it must have an integrated smoking cessation intervention … It is a teachable moment that should not be missed.
“Individual, ad hoc screening should be strongly discouraged, with no evidence of benefit and the very real risk of harm.
“The challenge facing Australia is the translation of international results into sustainable, cost-effective clinical practice, ensuring that the desired benefit outweighs the known harms, at the same time as enhancing tobacco control policies”, they concluded.
Overcoming the hurdles towards implementing lung cancer screening in Australia will be enhanced significantly by the recent announcement by the National Health & Medical Research Council that they are awarding $3m to fund further research into this area, led by Professor Kwun Fong (co-author) from the University of Queensland.