Lung cancer is Australia’s biggest cancer killer, often due to late diagnosis. But a federally funded screening program will offer hope when it comes to survival rates.
By Suzanne Harrison
About five years ago, now 69-year-old Leonie Bamford was told she had lung cancer. Her condition was symptomless, and the fact she had a diagnosis at all was sheer luck.
Not long before, Leonie and her husband, Alan, now 71, had made a routine visit to their GP to check out Alan’s persistent cough. Both being smokers, the GP gave them a leaflet about screening trials then underway at Fiona Stanley Hospital, so they decided to give it a go.
“The trial was just about finished, and they found a lump on my right lung which (over time) had changed form,” says the mother-of-three from her Kelmscott home, “so they did a biopsy, and it was cancerous.”
The immediate surgery that followed has saved her life. “If I hadn’t had been in the trial, I’d be dead by now,” said Leonie, now a non-smoker for four years.
Leonie was luckier than many. Lung cancer is the leading cause of cancer death in Australia, according to Cancer Australia, and estimates showed more than 8,600 Australians would die from it in 2022. Lung Foundation Australia says that it’s often diagnosed too late, when treatment options are limited, contributing to an extremely low, 20% five-year survival rate.
But if new screening programs are rolled out – in line with countries such as the UK and to some extent, the US – this could change.
In October last year, the Medical Services Advisory Committee recommended the Federal Government implement a national lung cancer screening program, with the aim of supporting earlier detection of lung cancer.
This welcome announcement resulted from an application from Cancer Australia, following extensive analysis into the feasibility of a national lung cancer screening program.
“The (MSAC) review was conducted independently and concluded with high certainty that the evidence showed the proposed program would reduce lung cancer mortality,” said Cancer Council Australia CEO Professor Tanya Buchanan at the time.
The advice received by MSAC includes a recommendation to implement a new Medicare item for low-dose, computed tomography scans for asymptomatic high-risk Australians (smokers or ex-heavy smokers) to help detect lung cancer earlier, which would ultimately provide greater treatment options and a higher likelihood of survival.
A study in late 2022 by Australia’s Daffodil Centre, and published in the British Journal of Cancer, strengthened the economic case for a targeted lung cancer screening program in Australia.
The study updated cost-effectiveness estimates in an Australian context based on the findings of two major international trials of lung cancer screening, the Dutch-Belgian NELSON trial and the US National Lung Screening Trial.
It showed that if the results were adapted to the Australian health system, lung cancer screening for Australians with a history of heavy smoking would have a favourable cost-effectiveness ratio given new evidence from the NELSON trial published in 2020.
This study helped inform the supportive recommendation to the government from the MSAC.
“The greatest challenge in cancer screening is ensuring that it delivers more benefit than harm to the population,” said Associate Professor and research fellow at the Daffodil Centre Marianne Weber.
“For most cancers, there are no tests for asymptomatic populations that work without causing significant harms, such as inaccurate results that lead to unnecessary harmful diagnostic tests and treatments, and stress for individuals affected and out-of-pocket costs.
“Governments also consider cost-effectiveness as a matter of course. These results, which show targeted lung cancer screening using low-dose computed tomography, could be more cost-effective than previous estimates indicated, strengthening the economic case for such a program.”
In 2019, Dr Weber wrote for Cancer Council NSW that only breast, bowel, and cervical cancers have national cancer screening programs in Australia, and on current evidence, low-dose CT scans for long-term smokers and ex-smokers are the most likely path towards targeted lung cancer screening.
As for Leonie, she was involved close to home in the International Lung Screen Trial at Fiona Stanley Hospital, a lung cancer screening program with the same low-dose chest CT. The ILST began with five centres in Australia and involved international collaborators in Canada, Hong Kong, England and Spain.
West Australian participants were recruited from the community and attended both FSH and Sir Charles Gairdner Hospital, led by FSH respiratory physician Dr Annette McWilliams and project manager Jacqueline Logan.
“Lung cancer kills so many people, but is so treatable when found early,” said Dr McWilliams, who has spent a large part of her career dedicated to lung cancer screening research, both overseas and more recently, in Perth with the ILST.
Dr McWilliams undertook a fellowship in Canada in 2000 on the viability of low-dose CT scans for lung cancer, and as of 2017, co-managed the ILTS trial.
“I’ve been working on lung cancer screening for 20-odd years, and I know that it works,” she said.
The challenge, however, is not whether early detection and government-funded scans reduce deaths, but the protocols of implementation.
“We’re moving from the world of research into clinical practice. We know low-dose CT reduces death rates in an organised program, but you need to have a standardised approach and the infrastructure in place to monitor it all,” she said.
Dr McWilliams said final details – such as the age range and risk assessments of those who qualify – were yet to be released.
“It has to be well thought out and done properly,” she said.
In the UK, mobile pilot programs have been implemented following government approval. The Targeted Lungs Health Check program focuses on those most at risk of lung cancer and will gradually expand.
Lung Foundation Australia’s CEO Mark Brooke said a screening program would bring lung cancer prevention in line with other leading cancers. Bowel, cervical and breast cancers all have a significantly higher five-year survival rate at 70, 74, and 92% respectively.
The screening program proposed by Cancer Australia includes a recommendation for seven mobile screening units, which will bring early detection services to regional and remote areas that currently face significant inequity of access.
Cancer Australia’s report found that not only will the program save over 12,000 lives in the first 10 years, it will also reduce the financial burden to the health system associated with lung cancer in the long term.
At FSH, Leonie was just one of the 21 WA participants in the ILTS study. Yet Dr McWilliams said that in WA alone, there were between 1200 and 1400 cases recorded each year, and with an ageing population, those rates would not be going down.
Leonie did not have to undergo chemotherapy, so believes she was one of the luckier ones. And apart from her breathing being “not as good as it used to be” she does now exercise regularly. Plus, her husband is also off the cigarettes and has been for a year.
“We’re feeling marvellous,” Leonie said, “and I am so grateful.”