Screening people at high risk for lung cancer – still Australia’s single biggest cancer killer – has the potential to save thousands of lives especially among former smokers, according to a new paper on the future of cancer screening in Australia. The paper is published just as the Federal Minister for Health, Greg Hunt, has ordered a fresh look at lung cancer screening, announcing a new inquiry into its feasibility.
Currently, only breast, bowel and cervical cancers are the subject of national cancer screening programs in Australia, and no country has nationwide screening for lung cancer. Although it is estimated lung cancer will kill more than 9,000 Australians this year – 60% more than bowel cancer, the second-biggest cause of cancer deaths – an Australian Government committee recommended in 2015 against lung cancer screening, calling for clearer local evidence on effectiveness, cost and feasibility.
But the new paper, in the latest issue of Public Health Research & Practice, published today by the Sax Institute, says the evidence of screening’s effectiveness is now strengthening – including national research using low-dose computed tomography (CT), which so far appears to be in line with previous research from the US and the Netherlands that found this screening technique could cut lung cancer deaths by at least 20%.
The new paper, by experts from Cancer Council NSW, University of Queensland and University of London, appears in a themed issue of PHRP that provides several expert perspectives on the future of screening programs for different types of cancer in Australia, including melanoma, prostate cancer and liver cancer.
The lung cancer paper says despite Australia’s many successes in tobacco control, lung cancer will remain a major health burden for many decades and the growing evidence to support screening warrants attention. Australian and Canadian researchers are now testing a statistical tool designed to identify high-risk people who would benefit from screening, as well as a method for telling which lung nodules picked up through screening are likely to be malignant.
“Overall, lung cancer screening is an opportunity to prevent thousands of lung cancer deaths, especially for former smokers who make up an increasing proportion of lung cancer cases,” the authors write.
Guest Editor of the themed issue Professor Karen Canfell, chair of Cancer Council Australia’s Screening and Immunisation Committee, says future expansions and improvements to screening programs are likely to be achieved through research targeted at specific, high-risk populations.
“Lung cancer is a good example,” Professor Canfell says. “It is a major health problem, it can be found early and it can be treated successfully. But we don’t yet know how to do this in an organised way.
“We need to identify the most appropriate group of people to screen, to maximise benefit and minimise the risk that looking for cancers in people without symptoms will find a lot of other things that cause unnecessary treatments and anxiety.
“But targeted research is helping us to answer these questions and should lead to more cost-effective, systematic ways to finding lung cancer early in people at increased risk.”
Melanoma is another promising candidate for screening. Melanoma accounts for 10% of all invasive cancer diagnoses in Australia each year and the costs for treating it are growing exponentially, note the authors of the perspective on this topic. Ad-hoc screening currently occurs when people visit their doctor and either ask for a skin check or the doctor proposes one to high-risk patients. But shifting to a national, risk-stratified program “may be a promising way forward to reduce the heavy burden” of melanoma, the authors write.
This themed issue of PHRP was supported by and developed in partnership with Cancer Institute NSW and Cancer Council Australia. Guest Editors are Professor Karen Canfell, Cancer Council NSW Director, Cancer Research; Professor David Roder, Chair of Cancer Epidemiology and Population Health School of Health Sciences, University of South Australia; and Paul Grogan, Cancer Council NSW Senior Strategic Adviser, Cancer Research.
Another highlight of this issue is the first comprehensive review of the benefits, harms and cost-effectiveness of cancer screening in Australia, authored by Professor Canfell and colleagues. This review finds that the three current population screening programs for breast, cervical and colorectal cancer are all cost-effective. The National Bowel Cancer Screening Program is particularly good value for money, with the analysis showing it costs just $3380 for each year of life saved.
In the Editorial, authors Professor David Currow, CEO of Cancer Institute NSW, and Professor Sanchia Aranda, CEO of Cancer Council Australia, write: “The overall theme of this issue is that for the benefits of screening to be maximised, we must be prepared to engage in ongoing analysis of program effectiveness, and be open to considering program changes to balance benefits, harms and costs. To do this well, we must invest in linked datasets that enable more complex understandings of the varying impacts of early diagnosis and improvements in treatment on mortality and survival across our community.”
- GP endorsement may be one of the most effective ways to boost low levels of participation in the National Bowel Screening Program
- We need to address screening inequities if we are to eliminate cervical cancer as a public health threat by 2040
- Simulation modelling could play a key role in identifying the harms and benefits of population screening policies
Nyssa Skilton, Editor, Public Health Research & Practice
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Megan Howe, Deputy Editor, Public Health Research & Practice
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