Lung Foundation Australia is calling for a $153 million pilot screening program for current and former smokers aged 55 to 74,and Indigenous smokers as young as 50,to be funded in the October federal budget.
Roy Martin,of Plumpton in western Sydney,was diagnosed with stage three lung cancer aged 62. He was declared cancer-free last year.Wolter Peeters
More than 80 per cent of the 11,000 lung cancers diagnosed in Australia each year are detected at a late stage (stage three or four),compared with half of bowel cancers and one in five breast and prostate cancers.
Lung cancer is also Australia’s most deadly cancer,with 8693 deaths in 2021. The five-year survival rate is just 20 per cent,the lowest of the country’s five most common cancers.
“Without a screening program,we are not going to see the number of late-stage detections shift,” said University of Melbourne Associate Professor Nicole Rankin,who oversaw Lung Foundation Australia’s reportThe Next Breath:Accelerating Lung Cancer Reform in Australia 2022-2025,which is being launched at Parliament House on Wednesday.
A screening program involving low-dose radiation CT scans every two years was back before the Medical Services Advisory Committee (MSAC) last week,after it recommended against the program earlier this year due to concerns about cost efficiency. The program was proposed by federal agency Cancer Australia in 2020 following an inquiry.
Modelling by PriceWaterhouseCoopers commissioned by Lung Foundation Australia showed screening would prevent 12,000 lung cancer deaths over a 10-year period.
“If we were saving 12,000 deaths from domestic violence or mental health,to be frank,we’d find the money,” said Mark Brooke,the foundation’s chief executive.
A large European trial found early screening reduced lung cancer deaths by 24 per cent over a decade but also resulted in a 9 per cent excess of detections over 11 years. This indicated that some people could be incorrectly diagnosed or over-diagnosed,as the scans also detect nodules that do not develop into cancer.
In its initial recommendation,MSAC also raised concerns about the stress of unnecessary diagnosis for patients. A public summary of MSAC’s reconsideration of the screening program will be published later this year. MSAC did not reply to a request for comment.
“From our perspective,having confirmation that you don’t have cancer is a positive outcome,not a negative one,” Brooke said.
The Royal Australian College of GPs said it “cautiously supported” lung cancer screening if GPs were the principal route of entry to the program.
“You can make inroads into the over-diagnosis problem by using the low-dose technology and getting the right group of people screened,” Rankin said. Low-dose scans had much greater accuracy with detecting nodules and determining whether they were cancerous,she said.
Concord Hospital respiratory physician Professor Lucy Morgan,who is chair of the foundation’s board,said lung cancer overwhelmingly affected lower socioeconomic communities. Indigenous Australians are twice as likely to be diagnosed as non-Indigenous Australians,and survival rates in remote or regional areas are 12 per cent lower than in major cities.
“The presentations are so dramatically different in poor Australians,” she said.
Morgan said the difference between diagnosing a person with stage one compared with stage three or four lung cancer was not only arduous months of chemotherapy but also whether the cancer was likely to be cured.
“And it is near impossible to know you have early-stage lung cancer;you don’t have a lump in your breast to feel or a spot on your skin to see,” she said. “The symptoms don’t present until the cancer is quite big.”
Other recommendations in the reportinclude investing in an additional 100 specialist lung cancer nurses by 2025 and improvements in mental health services for people diagnosed with the disease,which often comes with feelings of guilt and social stigma. There are 37 specialist lung cancer nurses in Australia at present.
Roy Martin,of Plumpton in western Sydney,was diagnosed with stage three lung cancer at the age of 62 after he noticed bleeding from his mouth. The former smoker was emotionally overwhelmed when the oncologist said he had a one-in-10 chance of survival.
“They keep throwing numbers at you and I had to say:‘that’s enough’,” he said. “Because it’s not one person being affected by this:I’m a husband,a father,a neighbour,a brother.”
Martin was declared cancer-free last year.
“My reaction was shock. If I’m the one in 10,I feel sorry for the other nine,” the disability worker,who is vice chairperson of the western Sydney branch of Special Olympics,said.
“I was doing a lot of coughing before the bleeding;I probably would have had reason to take[a screening program] up.”
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