National Lung Cancer Screening Program begins

GPs can now refer eligible Australians for free lung cancer screening under the National Lung Cancer Screening Program (NLCSP).
 
But anxiety and stigma are two of the key factors GPs will need to navigate with the launch of the program, according to an RACGP expert.
 
Launching on Tuesday, Australia’s first new screening program in almost 20 years offers low-dose CT scans to people aged 50–70 who smoke or have a history of smoking and do not have the symptoms or signs of lung cancer.
 
To be eligible for the NLCSP, current smokers must also have a history of tobacco cigarette smoking of at least 30 ‘pack years’, calculated by multiplying the number of cigarette packs smoked per day by the number of years the person has smoked.
 
There are two Medicare Benefit Schedule item numbers specific to the program for radiology providers, one for the two-yearly low-dose CT screening scan and one for the interval low-dose CT scans – both require mandatory bulk billing.
 
Patient results will be sent from the radiology provider to the National Cancer Screening Register, as well as being provided to requesting practitioners and electronic medical records.
 
RACGP Expert Committee – Quality Care Chair Professor Mark Morgan said he is pleased the program model, which was informed by input from the RACGP, has been kept user-friendly for GPs, unlike some ‘complex’ trial models abroad that required doctors to take family histories and other risk factors and weigh them all up in an online calculator.
 
‘The more approachable and simple decision-making that we’ve gone with here is much easier to use, and allows both patients and their advisors to work out whether or not people are eligible,’ he said.
 
The Federal Government has provided extensive guidelines and resources for healthcare providers on its NLCSP website, from how to reduce patient stigma, or how to start a conversation about screening, through to e-learning modules, enrolment forms for patients and imaging request forms.
 
Professor Morgan said GPs will need to spend time familiarising themselves with the program, particularly caveats that might temporarily preclude otherwise eligible patients from screening, such as recent chest CT scans, or recent infections such as acute bronchitis or pneumonia that would mean a CT scan will find ‘all sorts of leftover signs’ of the infection.
 
‘It’s not the best timing to have your low-dose CT scan, and this might be quite pertinent at this time of the year,’ he said.
 
Managing anxiety among patients concerned about scan results will also be an important part of GPs’ involvement in the program, Professor Morgan said, particularly for scans that require follow-up.
 
‘People will need to be reassured that a further CT scan doesn’t necessarily mean that they have lung cancer; it’s just that they need to be watched more carefully,’ he said.
 
‘But of course, from an individual, what they might hear is “they found a spot on my lung, and they’re worried about it”, and put their life on hold.
 
‘There’ll be quite a lot of anxiety and other things for GPs to manage associated with this program.’
 
RACGP President Dr Michael Wright agreed, saying anything that comes up on a scan is potentially going to be scary for patients.
 
‘The scans are likely to pick up other things like emphysema or coronary calcium which we’re probably aware of before we send people along, but that might be information that’s useful to us,’ he told newsGP.
 
‘It will be important that we as GPs know what the implications of particular findings are and that we’ve got pathways available to refer people on if we need to. 
 
‘There’s always a concern that we have incidental findings and that they might be a really high concern for patients, so that’s one of the things we just need to monitor to make sure that it’s actually picking up the important diagnoses and not over-diagnosing less important things.’

For Naomi Fitzakerley, a patient eligible for the screening, she hopes the program will help address a stigma she says is still felt by many smokers and ex-smokers around being tested for lung cancer.
 
‘One of the things that you get told is that you’ve caused it,’ she said.
 
‘Something like this amazing program is going to normalise and destigmatise the people getting lung cancer screening.’
 
Professor Morgan also advised GPs to check their IT systems can generate request forms for scans, and that their usual radiology services are part of the NLCSP ‘and ready to go’, to ensure patients are not subject to additional stress.
 
‘Otherwise, it just takes time and creates more uncertainty for patients, if they’re all keyed up to have their scan, but then can’t find somebody to do it,’ he said.
 
The NLCSP provides a significant opportunity for GPs to have conversations with patients not only about eligibility for screening, but for smoking cessation, Professor Morgan said.
 
This was particularly relevant for high-risk groups such as people in rural and remote regions – who will benefit from mobile screening trucks delivering services nationally from November – as well as for those living with mental illness.
 
‘We know that smoking rates are actually higher in some rural and remote areas, and we know that many of the populations that are relatively underserved have high smoking rates,’ Professor Morgan said.
 
‘For people with serious mental illness, the smoking rate is around 50%, and it may well be quite a long way down the normal priority list for people with serious mental illness to be thinking about joining another screening program. But they are a high-risk group that you’d want to actively engage.’
 
In Australia, lung cancer is the fifth-most diagnosed cancer and the leading cause of cancer deaths. Last year, more than 15,000 people in Australia were estimated to be diagnosed with the disease.
 
The Medical Services Advisory Committee has recommended reviewing the program within the first two years of implementation to assess the effectiveness of the program and its delivery model.
 
Professor Morgan said the program launch will be reflected in an update to the Red Book chapter on lung cancer, due to be published next week and supported by additional training for GPs.
 
For more information, resources targeted at healthcare professionals are now available on the Department of Health, Disability and Ageing website.
 
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