Although it could be doing better, according to an Australian expert.
Almost 100,000 people have participated in Australia’s national lung cancer screening program since its launch in July 2025, with 285 joining the program every day on average, according to federal health minister Mark Butler.
Early data insights from the National Lung Cancer Screening Program suggested that around 2% of results were very suspicious and required urgent review, 3% were suspicious, 1% were probably benign and required follow-up in six months, 4% had a benign appearance, 86% were negative, and 4% were indeterminate/incomplete.
The average patient age was 62. Forty-seven percent were female, with 17% having a family history of cancer, 75% no family history, and 8% unknown.
“I think we’re getting appropriate referrals out of the program, definitely,” Professor Matthew Peters, head of Respiratory Medicine at Concord Hospital and a previous president of the Thoracic Society of Australia and New Zealand, told Oncology Republic.
“Some cancers have been found at a curable stage that wouldn’t have been found without a CT, and that’s terrific,” he said.
“Where we are looking, it’s a valuable tool, but we’re missing out on some patients because we’re omitting some at significant risk. That’s something to be considered by the people who are dedicated to implement and run the program,” said Professor Peters.
The rate of detection was lower than in the trials, but that was not a surprise, he said, because in Australia, lung cancer in current and former smokers was occurring at older ages and in former smokers who’d quit long ago.
“It’s unrealistic to think that the addition of the screening program is suddenly going to see lung cancer cases plummet because we’re mostly looking in the wrong place for lung cancer in Australia,” said Professor Peters.
The program is currently available to high-risk individuals, defined as asymptomatic people aged 50 to 70 with a history of tobacco smoking of at least 30 pack-years, or having quit within the past 10 years if they are a former smoker.
“If we wanted to find more lung cancers in the screening program, two important things would be extending the upper age range and dispense with the 10-year limit. There’s no evidence that the lung cancer risk diminishes after 10 years. It remains the same after you quit,” Professor Peters suggested.
“We’ve been largely successful in tobacco control in Australia, which means that our patients have lower smoking histories and higher rates of smoking cessation than there was in America or Europe at the time when the major studies were done,” he said.
“The other thing is that we have to accept the compromise of having a general-practice-based screening program, because what we’ve done with smoking history, age, and smoking cessation, it’s not the best way to identify people at lung cancer risk,” he said.
Basing the program in general practice was a less optimal way of selecting patients than the UK’s expert-centre-based screening program, which used complex risk calculators, he said.
Professor Peters said GPs were becoming more familiar with the conversations that needed to happen with patients around scan results and giving patients confidence about the next steps.
“This was always a challenge. When we do a CAT scan on the people in the age range that we’re targeting, most people have a nodule, and many of those nodules are not of a characteristic that there’s any concern,” Professor Peters explained.
“‘We found something, you don’t need to worry about it, you can have a scan in 12 months or in two years’, and then, ‘Look, we found something, we’re a little bit worried about it. We’re going to bring the next scan forward’.
“It’s a difficult skill, and I admire the GPs who’ve taken those conversations on, and who are not simply sending along every tiny nodule that doesn’t matter to see a specialist,” he said.
“Sure, there are some patients who can’t digest that advice that there’s something but there’s no need to do anything. And yes, across the system there are some patients who’ve been referred to specialists that don’t need that referral.
“But that’s part of the birth pains of the program. And I guess we expected it, and it’s not a failing of general practice, because both the GP and the patient have to be satisfied that the instructions they get from the radiologist report are the ones they should follow with confidence.”
A concern prior to the commencement of the national screening program was that there would be many incidental findings. Some of these would be important, catching extrapulmonary cancers, cardiovascular, and respiratory conditions early, but others would lead to unnecessary investigations and anxiety.
The data insights suggested that around 60% of those screened had additional cardiovascular findings, 47% in the lung, 31% had bone findings, 14% in the abdomen, 2% thyroid, 1% pleura, 1% breast, and 1% mediastinum additional findings.
Professor Peters said the concerns about incidental findings were “really strange”.
“No one ever said we shouldn’t do screening CTs for coronary arteries because we might find something incidental, and to me that’s sort of like a guerrilla campaign against lung cancer screening.
“Sure, we’ll find some incidental things. Some of those are important, some of those are not. But there’s barely a screening program that hasn’t got a false positive rate or incidental things.”
Just like with other programs, incidental findings added to the program’s costs, he said.
“And some of those are important costs, because they save people’s lives or improve their health, and some of those costs are not necessarily beneficial for the individual or the system, but that’s just how it flows.”
The program is available nation-wide, including mobile scanning in northern Western Australia and the Northern Territory, in partnership with Heart of Australia. So far, 519 scans have been carried out this way and more mobile services will be rolling out around the country over the next 10 months.
Related
The National Lung Cancer Screening Program was designed together with the National Aboriginal Community Controlled Health Organisation (NACCHO) and First Nations people make up 5% of those screened, the government said.
“Strong uptake of lung cancer screening by Aboriginal and Torres Strait Islander people in the program’s first year is not a happy accident; it is what happens when screening is built to be culturally safe, delivered through Aboriginal Community Controlled Health Organisations, and backed by a growing Aboriginal and Torres Strait Islander cancer workforce,” said Dr Dawn Casey PSM, NACCHO CEO.
“Lung cancer claims more Aboriginal and Torres Strait Islander lives than any other cancer, and too often it is found too late. Early detection changes that, and it means more of our people are home with family, on Country, for longer.
“The lesson for every national health program is simple: co-design with the community-controlled sector is not a courtesy. It is the reason this program is working for our people.”
“After screening, participants are supported to take the next step based on their results, whether that means returning for routine screening, undertaking closer monitoring, or being referred for specialist care,” the government said.
