The Royal Australian College of General Practitioners is urging a “soft launch” for Australia’s first national lung cancer screening program, set to begin this year, to address significant challenges it identifies in the program’s draft guidelines. The call is part of a suite of recommendations aimed at ensuring the rollout is both effective and sustainable for GPs and their patients.
In feedback provided to Cancer Australia this week, the RACGP highlights the potential to significantly increase the workload for GPs, who are expected to handle patient education, eligibility assessments, referrals, and follow-ups – including managing incidental findings. This burden is likely to hit hardest in practices serving socioeconomically disadvantaged populations, where patients often present with multimorbidity, mental health concerns, and complex social needs, says RACGP president, Dr Michael Wright.
While the College stresses that these challenges should not delay the program it insists on robust support systems to safeguard its success. It proposes a phased rollout, beginning with lower screening volumes to help GPs manage the extra workload and resolve issues early. It also recommends ongoing evaluation to ensure the program adapts to the needs of healthcare providers and patients.
The lung cancer screening program is designed to reduce mortality by detecting cases earlier, with primary care providers playing a central role in engaging at-risk populations. The RACGP emphasises that equity must be at the heart of the initiative, calling for targeted outreach to vulnerable groups such as individuals with severe mental illness and substance use disorders – populations often overlooked in preventive health programs despite higher smoking rates and poorer health outcomes.
Beyond this, the College says clear communication and defined roles among healthcare providers are critical to the program’s success. If a non-GP specialist initiates a low-dose computed tomography (LDCT) scan, they must follow up on the results in consultation with the patient’s GP, it recommends. Ideally, patients should be referred back to their regular GP – someone with whom they have an ongoing relationship – to ensure continuity of care and appropriate follow-up. This collaborative approach is essential for effective care coordination and avoiding gaps in patient management.
Integration with the National Cancer Screening Register remains a sticking point. The RACGP highlights technical issues that could hinder seamless data access and reporting, urging clinical system vendors to resolve them. It also recommends amending program guidelines to ensure screening results are uploaded to My Health Record automatically, enhancing care coordination.
Administrative and financial hurdles are also in focus. Raising concerns about the time-consuming task of identifying appropriate radiology providers and multidisciplinary teams, the College recommends a government-maintained database of registered screening providers and qualified specialists.
Financial barriers could further complicate access, the college warns. While the initial low-dose CT scan is free, follow-up tests and consultations may involve out-of-pocket costs, particularly for rural patients facing travel expenses, the College states in its submission. The RACGP stresses the need for transparency around costs to ensure patients are not deterred from participating.
Meanwhile, culturally safe care is another priority. The RACGP stresses that ‘principles alone are insufficient’ and calls for practical tools, training, and accountability measures to ensure healthcare services can meet the needs of diverse populations.
Incidental findings such as coronary calcification or emphysema are an added complexity of screening, the RACGP notes. These findings, while clinically significant, could lead to anxiety or unnecessary testing if clear referral pathways are not established. The college calls for comprehensive guidelines to manage these findings, tailored to different healthcare settings, including rural areas.
The RACGP also suggested leveraging LDCT scans to provide broader insights into patients’ health, such as assessing coronary calcium scores or identifying other lung conditions. While not the primary goal, this approach could enhance the program’s value, it adds.