Call for ‘soft launch’ of lung cancer screening program

A nationwide lung cancer screening program should be introduced gradually to mitigate workload concerns, according to the RACGP.
 
The suggestion is included in the college’s response to Cancer Australia’s consultation on healthcare provider guidelines for the new National Lung Cancer Screening Program (NLCSP).
 
The program, announced last year and due to start this July, differs from existing cancer screening programs with eligibility focused on the most at-risk individuals rather than using age as the only criteria.
 
These include asymptomatic Australians aged 50–70 years old with a history of at least 30 pack-years of cigarette smoking who either currently smoke or have quit within the past decade.
 
Under the program guidelines, they will be offered a bulk-billed low-dose computed tomography (LDCT) scan every two years, as well as follow-up scans depending on the initial results.
 
According to the RACGP, the screening program is expected to have the greatest impact on workloads for general practices with more socioeconomically disadvantaged patients who are most likely to be eligible for screening.
 
‘These patients often experience multimorbidity at a younger age and have complex mental health and social challenges,’ the submission states.
 
‘This is not an argument against the program, but it does highlight additional workload for GPs is likely underestimated and under-resourced, particularly in practices that already have high and complex workloads.’
 
A gradual implementation, including ‘a soft launch or slow build-up of screening volumes’, would help mitigate those concerns, the RACGP consultation states.
 
‘This could help manage potential increases in workload and allow any issues to be resolved early under lower demand.
 
‘In addition, the program should evaluate the additional workload of GPs to ensure any future improvements can be considered and implemented.’
 
The RACGP’s feedback also noted that general practices will be central to the initiative’s success, with the fact that almost 90% of Australians visit their GP every year offering ‘a clear route’ into the screening program.
 
However, the submission to Cancer Australia also warns of previous issues with integration of the National Cancer Screening Register into clinical information systems.
 
‘If not already addressed, there needs to be appropriate attention and rectification of any issues to ensure seamless access and reporting is achieved,’ the RACGP submission states.
 
It recommended guidelines clearly state there should be an automated upload of results to My Health Record.
 
The college also recommended setting up an accessible database of registered screening providers and physicians linked to a lung cancer multidisciplinary team, as well as clarifying how results will be communicated if the scan is requested by a non-GP specialist.
 
A further recommendation was made to develop accessible guidelines for managing incidental findings, as well as to expand the program to those with serious mental illnesses and substance abuse disorders.
 
A national lung cancer screening program has been considered for several years, but previously higher radiation doses of CT scans proved a barrier, the Chief Executive of Cancer Australia told newsGP in 2019.
 
However, improvements in low-dose CT scans have boosted the potential of a wider screening program to safely diagnose the disease earlier and increase survival rates.
 
According to the Australian Institute of Health and Welfare, lung cancer is the deadliest of all cancers in the country, with an estimated 8900 Australians dying of the disease in 2024.
 
Many of those have historically being diagnosed at a late stage.
 
From 2016–20, the five-year survival rate of lung cancer stood at just 26%, compared to the next lowest, colorectal cancer, at 71%.
 
The vast majority of lung cancer diagnoses are linked to smoking.
 
The NLCSP is being implemented in a partnership between the Federal Government and the National Aboriginal Community Controlled Health Organisation. 
 
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cancers low-dose computed tomography lung cancer National Lung Cancer Screening Program