Lung cancer remains Australia’s leading cause of cancer death. One of the biggest challenges is that it is often diagnosed at a later stage, when treatment options are more limited.
Finding lung cancer earlier can make a significant difference. But establishing a population-wide screening program requires more than knowing that a test works. Decision-makers also need evidence about who should be screened, the likely benefits, and whether a program represents an effective use of health resources.
Over the past two decades, data from the 45 and Up Study has helped Australian researchers answer some of these questions – contributing to the evidence base supporting Australia’s first new national cancer screening program in nearly 20 years.
Building an Australian evidence base
Researchers from the Daffodil Centre – a joint venture between Cancer Council NSW and the University of Sydney – have used 45 and Up Study data across a series of studies investigating lung cancer risk, prevention and screening.
Earlier research using the Study helped examine the relationship between smoking and cancer risk and validate a tool for identifying people at higher risk of developing lung cancer in an Australian population.
This growing body of research became particularly valuable as Australia considered introducing targeted lung cancer screening using low-dose CT scans.
A major study led by the Daffodil Centre examined whether such a program could be cost-effective in the Australian health system.
Crucially, 45 and Up provided Australian population data that allowed researchers to estimate how many people would potentially be eligible for targeted screening, as well as their underlying risk of lung cancer.
Linked 45 and Up Study data also informed earlier research that provided detailed Australian estimates of healthcare costs associated with lung cancer. Together with Australian data on smoking, lung cancer risk, mortality and survival, these findings provided important inputs for modelling the potential costs and benefits of screening.
Making the case for screening
Published in the British Journal of Cancer, the analysis applied the outcomes of two major international lung cancer screening trials – NELSON and NLST – to the Australian population.
The researchers found that screening could be cost-effective in Australia if the reductions in lung cancer deaths achieved in international trials could also be achieved in clinical practice here.
Using outcomes from the NELSON trial, the estimated cost was $39,250 for each quality-adjusted life year gained.
The study became part of the evidence base supporting the development of Australia’s National Lung Cancer Screening Program, alongside international clinical trials, Australian research and extensive feasibility and policy work.
In May 2023, the Australian Government announced it would establish the program. Just over two years later, on 1 July 2025, screening began.
From evidence to action
The National Lung Cancer Screening Program now offers free low-dose CT screening to eligible Australians at high risk of developing lung cancer.
And the impact is already beginning to emerge.
Behind those numbers is the opportunity to find lung cancer earlier, when treatment is more likely to be effective. For individuals and their families, earlier detection can mean more treatment options and a better chance of improved outcomes.
It is a powerful example of the pathway from long-term research to policy and, ultimately, to changes in care that can make a meaningful difference to people’s lives.
The contribution of the 45 and Up Study was possible because researchers could draw on information collected from hundreds of thousands of participants over many years and link it with other health data.
Together, this data has helped researchers better understand who is at risk of lung cancer and provided Australian evidence to inform decisions about how screening could work in practice.
Twenty years of research that makes a difference
When more than 250,000 people joined the 45 and Up Study, they could not have known all the questions their information would eventually help researchers answer.
Twenty years later, their contribution has supported research across cancer, dementia, cardiovascular disease, mental health and many other areas of health and ageing.
The story of lung cancer screening shows what can happen when long-term research reaches beyond the research community – helping to build the evidence decision-makers need to improve health care.
That legacy is also helping to shape the next generation of longitudinal research. Building on the success and experience of 45 and Up, the 18 and Up Study will extend this approach across generations, creating new opportunities to understand how health and wellbeing change throughout our lives.
As we celebrate 20 years of the 45 and Up Study, we thank our participants for making research like this possible. Their contribution continues to generate evidence that can improve health and wellbeing for Australians today – while helping lay the foundations for the research of tomorrow.
