Australia doesn’t have to wait for all the answers before starting a lung cancer screening program – it should instead “jump in and do it”.
Speaking to the limbic after the Australian Lung Cancer Conference (ALCC) 2020 in Melbourne, Dr Henry Marshall said it made sense to get started and then tweak the program as new evidence becomes available.
Dr Marshall, a thoracic physician at the Prince Charles Hospital, Brisbane, and an investigator on the International Lung Screen Trial (ILST), said the research community was very hopeful for at least a demonstration project.
“Otherwise we are just going to be endlessly arguing about how to do it and never actually do it. You’ve got to take the plunge. We won’t have all the answers necessarily first up but Australia is pulling together a really good team of multidisciplinary expertise to make sure we get it as right as possible.”
“We are very clear that this is not a set and forget screening program.”
As reported in the limbic, the recent NELSON study in Europe showed that low-dose CT screening of targeted high risk patients reduced lung cancer mortality, prompting UK experts to push ahead with a national screening program.
Dr Marshall said that globally, everyone agrees that lung cancer screening reduces mortality – and the focus should now be on implementation.
“The consensus is that screening is going to be really important to do and we need to do it. This is the world’s largest cancer killer; this is Australia’s largest cancer killer. We don’t have a screening program for it as it has kind of been pushed to the bottom of the pile time and time again.”
He said Cancer Australia has just closed the public consultation phase of its lung cancer screening inquiry and a report is expected to be delivered to the health minister in October.
He added that Dr Vivienne Milch, director of cancer care at Cancer Australia, had highlighted at ALCC the complexities of screening but also the potential.
“One of the things that stuck in my mind was this is going to be the first cancer screening program in a decade maybe. It’s definitely the first screening program in the digital age and we have all this opportunity to harness that technology to make this better, faster, etc.”
For example, nodule detection software offered the opportunity to minimise the variability between radiologists across thousands of scans.
He added that the ILST was also addressing questions such as the value of risk prediction algorithms over standard eligibility criteria for selection of screening participants or multivariate risk prediction algorithms versus nodule size for nodule follow-up.