REPORT ON THE LUNG CANCER SCREENING ENQUIRY REPORT ON THE LUNG CANCER SCREENING ENQUIRY REPORT ON THE LUNG CANCER SCREENING ENQUIRY Report on the Lung Cancer Screening Enquiry was prepared and produced by: Cancer Australia Locked Bag 3 Strawberry Hills NSW 2012 Australia Freecall 1800 624 973 +61 2 9357 9400 canceraustralia.gov.au © Cancer Australia 2020. ISBN Print: 978-1-74127-355-7 ISBN Online: 978-1-74127-356-4 Recommended citation Cancer Australia, 2020. Report on the Lung Cancer Screening Enquiry, Cancer Australia, Surry Hills, NSW. Copyright statements Paper-based publications This work is copyright. You may reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. 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Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from Cancer Australia to do so. Requests and inquiries concerning reproduction and rights are to be sent to the Publications and Copyright contact officer, Cancer Australia, Locked Bag 3, Strawberry Hills, NSW 2012. Disclaimer Cancer Australia does not accept any liability for any injury, loss or damage incurred by use of or reliance on the information. Cancer Australia develops material based on the best available evidence, however it cannot guarantee and assumes no legal liability or responsibility for the currency or completeness of the information. III REPORT ON THE LUNG CANCER SCREENING ENQUIRY CONTENTS 1. Introduction and process ...............................................................................................2 1.1 Introduction ..................................................................................................................................................................2 1.2 Process ............................................................................................................................................................................3 2. Context ..............................................................................................................................5 2.1 Lung cancer in Australia ...........................................................................................................................................5 2.2 Stage at diagnosis .......................................................................................................................................................6 2.3 Risk factors for lung cancer .....................................................................................................................................7 2.4 Policy context ...............................................................................................................................................................8 2.5 International initiatives .............................................................................................................................................9 3. Evidence for screening ................................................................................................ 11 3.1 Benefits and harms .................................................................................................................................................. 11 3.2 Targeted screening .................................................................................................................................................. 12 3.3 Screening interval .................................................................................................................................................... 13 4. Stakeholder support ..................................................................................................... 14 5. National Targeted Screening Program ...................................................................... 16 5.1 Guiding principles ................................................................................................................................................... 16 5.2 Screening and assessment pathway ................................................................................................................. 17 5.3 Participant recruitment ......................................................................................................................................... 18 5.4 Eligible population .................................................................................................................................................. 19 5.5 Informed consent .................................................................................................................................................... 19 5.6 Smoking cessation .................................................................................................................................................. 20 5.7 Low Dose Computed Tomography ................................................................................................................... 20 5.8 Clinical assessment and management ............................................................................................................ 21 5.9 Screening Register ................................................................................................................................................... 21 5.10 Summary policy components ............................................................................................................................ 22 6. Workforce ....................................................................................................................... 25 6.1 Key Workforce Groups ............................................................................................................................................ 25 6.2 Workforce Impact ..................................................................................................................................................... 27 7. Implementation ............................................................................................................. 28 IV REPORT ON THE LUNG CANCER SCREENING ENQUIRY 8. Program costings and cost effectiveness ................................................................ 30 8.1 Program costings ..................................................................................................................................................... 30 8.2 Cost effectiveness .................................................................................................................................................... 31 9. Program governance ................................................................................................... 33 9.1 Health Ministers’ Endorsement ........................................................................................................................... 33 9.2 Governance structure ............................................................................................................................................. 33 10. Quality Assurance, Evaluation and Research ........................................................ 35 10.1 Quality Assurance ................................................................................................................................................... 35 10.2 Data and research .................................................................................................................................................. 36 Acknowledgements ............................................................................................................ 39 V REPORT ON THE LUNG CANCER SCREENING ENQUIRY FOREWORD In August 2019 the Hon Greg Hunt MP, Minister for Health, requested that Cancer Australia conduct an enquiry into the prospects, process and delivery of a national lung cancer screening program in Australia. Cancer Australia has undertaken a multi-faceted body of work underpinned by extensive and inclusive stakeholder consultation to enquire into the national and international evidence of the effectiveness of lung cancer screening, to design a lung cancer screening program appropriate for Australia, and to describe how