Australia Launches Lung Cancer Screening Program for Smokers
The screening program is a 'game-changer' for Australia, Lucy Morgan, MD, PhD, respiratory physician at Concord and Nepean Hospitals in Sydney, told Medscape Medical News. 'This [program] gives us the opportunity to offer cure to people who would otherwise develop Australia's most deadly cancer.' Morgan is also chair of the Lung Foundation Australia and a member of the screening program's expert advisory committee.
Early Diagnosis Crucial
Shalini Vinod, MD
Lung cancer is the fifth most diagnosed cancer in Australia and the most common cause of cancer death, claiming around 9000 lives per year. Survival rates for lung cancer (around one quarter of those diagnosed survive for 5 years) are far below those of more common cancers, including breast cancer, which has a 5-year survival rate of above 90%, and colorectal cancer, which has a 5-year survival rate of above 70%.
The reason for the low survival rate of lung cancer is that by the time it is symptomatic, it's often advanced, said Shalini Vinod, MD, radiation oncologist at the University of New South Wales Sydney. 'Approximately in half the cases that I pick up, the cancer has spread beyond the lungs and so is incurable,' said Vinod, who is on the expert advisory committee for the program.
Lung cancers that are detected early, before they have spread, have a much better prognosis and better treatment options, Vinod said. The most common approach for early lung cancer is surgery to remove the tumour or radiotherapy. 'If they're 2 centimetres or less, they're eligible for minimally invasive surgery…where rather than taking a whole lobe of the lung out, you can just take a part of the lobe with equivalent outcomes,' she told Medscape Medical News .
The program, which was launched on July 1, is recruiting smokers aged 50-70 years who currently smoke or have quit in the past 10 years and have a smoking history of at least 30 pack-years.
Henry Marshall, MD, PhD
Only a handful of countries worldwide, including the United States, the United Kingdom, South Korea, Taiwan, and Canada, have national or regional lung cancer screening programs, which all vary slightly in the choice of screening interval, age range, and smoking history. For example, the US Preventive Services Task Force recommends yearly screening.
The choice of 2-yearly screening was an effort to balance cost and benefit, said Henry Marshall, MD, PhD, a thoracic physician at the Prince Charles Hospital and University of Queensland Thoracic Research Centre in Brisbane. 'It's as effective in terms of its health benefit, but of course a lot cheaper because you're immediately halving the number of scans that you need to do,' said Marshall, who is also a member of the screening program expert advisory committee.
Australia's Unique Challenges
Australia faces unique challenges in implementing a national screening program like this one. The first is that lung cancer is the most diagnosed cancer and the most common cause of cancer death among Aboriginal and Torres Strait Islander people, with incidence and mortality rates around twice those of non-Aboriginal Australians.
'Some of it is about living in rural and remote Australia, some of it is about smoking rates, some of it is probably about genetic predisposition; we don't understand that completely,' said Morgan. 'And much of it is about access to health care.'
To address this disparity, the program was developed in partnership with the Aboriginal Community Controlled Health Organisation sector and First Nations people to ensure that the design and implementation was community-led and culturally appropriate and that the information and education materials were tailored to the community.
The program includes a mobile CT screening service to reach Australians in rural and remote areas because 'there are millions of Australians living more than four hours away from a CT scanner,' said Morgan. Five mobile screening trucks will be deployed around the country beginning in November this year.
Participants must be initially referred for screening by their general practitioner (GP). If anything is detected on CT, they are then referred to another clinician according to a nodule management protocol that was developed specifically for the program.
The Royal Australian College of General Practitioners has expressed concern about the potential increased workload for GPs, particularly those in areas of socioeconomic disadvantage, where greater numbers of patients are likely to have histories of heavy smoking and therefore be eligible for screening.
The program will also lead to increased pressure on radiology and cardiothoracic surgery services in Australia, Vinod said, but another concern is whether smokers will actually sign up for the program. Uptake for breast cancer screening in Australia is around 50%, and uptake for bowel cancer screening is around 40%. 'If you just benchmark it against those, this is going to be tough because this is a cancer where there is a lot of stigma,' Vinod said.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
CBS News
an hour ago
- CBS News
Colorado agency that administers Medicaid will make big changes under new federal law
Agency that administers Medicaid will make big changes under new federal law, state official says Agency that administers Medicaid will make big changes under new federal law, state official says Agency that administers Medicaid will make big changes under new federal law, state official says As executive director of the Colorado Department of Health Care Policy and Financing, Kim Bimestefer oversees the state's largest health insurance program. Kim Bimestefer, executive director of the Colorado Department of Health Care Policy and Financing CBS Medicaid covers 1.2 million Coloradans, or one in five residents. Verifying the eligibility of so many people each year is already a colossal task. Bimestefer says, under President Donald Trump's new tax and spending law, it will become far more challenging. "We've got to set up an entire industry in 18 months," Bimestefer said. Bimestefer says the state has sophisticated software that can automatically check things such as age, income, address and citizenship. But the new law creates new requirements, including 80 hours of work, school or community service each month for people between the ages 19 and 64 who aren't pregnant, disabled or have kids under age 14. There is no automated system for that or a master list to know who's in school and who's volunteering to verify eligibility. And Bimestefer notes the state now must do that verification twice a year. "We have to build the entirety of the infrastructure to capture and automate and to make sure that we don't have people impeded of getting through the eligibility process and therefore losing coverage," Bimestefer said. "Because the down-streaming impacts of people losing coverage are absolutely catastrophic." Bimestefer says up to 377,000 Coloradans could be impacted by the new eligibility requirements. It's estimated about 56% of them are already working, but Bimestefer says verifying that will be the challenge. Bimestefer worries thousands of Coloradans will lose coverage. "They'll move. They'll change their email address. They won't realize have to do it," Bimestefer explained. That will lead to more uninsured patients, Bimestefer says, and more uncompensated care, which will increase costs for everyone. "The north star is to have people covered but, again, this is going to be part of many difficult decisions that this state is going to have to step up and make," Bimestefer said. While most of the changes to Medicaid -- including the new eligibility requirements -- don't take effect for at least a year and a half. Bimestefer says she needs to start preparing now, which takes money. Bimestefer says lawmakers -- who decide what services are covered -- will have to make tough decisions soon. Gov. Jared Polis is expected to call them back to work next month. The new law provides $200 million to help with implementation, but the money will be shared among all states. The state of Kentucky alone spent about $270 million on a work requirement only before a court blocked it. "Are we going to lower provider reimbursements? Are we going to change benefits? All those are very difficult decisions," Bimestefer said. "But were going to have to move some of those levers in order to deal with the fiscal realities that the costs will continue to go up, and the revenues available will continued to be strained." Bimestefer says, not only will Colorado have to spend millions of dollars on new hires and new systems to implement the law, it will have to do so as it loses millions of dollars. Starting in 2027, the law limits federal matching funds that Colorado has used to increase provider reimbursements. The state budget is already expected to take a billion-dollar hit from other provisions in the law, so the legislature won't be able to backfill the lost revenue, which Bimestefer says could be as much as $2.5 billion. She says the money has helped double the number of providers that accept Medicaid over the last 5 years. If reimbursement drops, providers may limit how many Medicaid patients they see. The law provides $50 billion to help offset the loss of funds for rural hospitals, which see the most Medicaid patients. Bimestefer says the state should know in the next few months how much of that money Colorado will receive. The original bill included a provision that cut additional federal funding to states like Colorado that pay for health care for undocumented immigrants, but that was dropped from the final bill. Bimestefer says that doesn't mean the Cover All Coloradans program won't face cuts. It was expected to serve about 3,600 people this year at a cost of $27 million, but it serves nearly six times that -- 21,000 -- at a cost of more than $50 million.
Yahoo
2 hours ago
- Yahoo
Health minister says funding of medication for B.C. girl's rare disease denied again
A Langford family that was hoping the province would reverse its decision for drug coverage to treat their daughter's rare disease is angry after coverage was refused for a second time. The minister of health says an independent medical committee that examines these rare drugs has determined the drug, which costs about $1 million a year, will no longer help the girl's condition. Meera Bains reports.
Yahoo
3 hours ago
- Yahoo
Kennedy's move to cancel preventive health panel meeting raises alarm
If you've ever been given a free or low-cost test for lung, breast, colon or cervical cancer which caught a tumor, it's likely due to a panel of 16 doctors and public health experts who reviewed the evidence and determined that a screening could save your life. That's why anxiety is growing after Health and Human Services Secretary Robert F. Kennedy Jr. abruptly postponed a meeting this week with the highly influential United States Preventive Services Task Force, a group of 16 independent volunteers that advise the agency about preventative health services and screenings, including mammograms, HIV prevention medications, recommending support for new moms to breastfeed and lifestyle interventions for heart disease. Health insurance plans are required to cover the task force's recommendations under the Affordable Care Act. The meeting, scheduled for July 10, was postponed without explanation. In an emailed statement, Andrew Nixon, an HHS spokesperson, declined to say why the meeting was canceled or whether it would be rescheduled. He did not respond to a follow-up request for comment. An HHS notice sent Monday afternoon to task force members said the agency 'looks forward to engaging with the task force to promote the health and well-being of the American people,' according to two people familiar with the task force meeting. Task force members were not given a reason for the canceled meeting or whether it would be rescheduled, said the two people interviewed, who spoke on the condition of anonymity for fear of retribution. Many task force members, however, fear Kennedy's move could signal that he's gearing up to fire them and install new members, as he did with a separate advisory committee, known as the Advisory Committee on Immunization Practices (ACIP), the sources said. Last month, Kennedy fired all 17 members of ACIP — which makes recommendations to the Centers for Disease Control and Prevention on vaccines, including for children — and replaced them with eight new members. The new panel includes well-known vaccine critics. 'If you look at how things played out with ACIP, this could be a warning signal,' one of the people said. The United States Preventive Services Task Force is a lesser known group that was first convened in 1984 during the Reagan administration. It includes physicians, nurses, pediatricians and public health experts. The task force plays an important role because the ACA , more commonly known as Obamacare, mandates that most private insurers provide the services that the group recommends to patients at no cost. The task force makes its recommendations using a grading scale. Under federal law, services that get an A or B grade but must be covered by insurance plans at no cost to patients. The advisory group has been subject to outrage for its past decisions, including from conservative groups over an 'A' recommendation to cover the HIV prevention pill, known as PrEP. Its controversial decision against routine blood test screening for prostate cancer in 2008 has been linked to rising rates of advanced cases of the disease. The task force currently advises against PSA-screening for older men, saying that men ages 55 to 69 should talk with their doctors about the benefits and harms. The group usually updates its recommendations every five years after reviewing the latest science on preventive care. For example, in 2021, the task force updated its guidance on heart attack prevention, saying most adults shouldn't take aspirin to prevent a first heart attack or stroke. Other recommendations from the task force include that all women begin breast cancer screening every other year starting at the age of 40, down from age 50. It also recommended that children and teens age 8 and up get screened for anxiety. Both have 'B' recommendations. The canceled meeting was set to discuss cardiovascular disease and prevention in adults and children, the people said. 'This institution proves vital,' said Arthur Caplan, the head of the Division of Medical Ethics at NYU Langone Medical Center in New York City. 'The task force provides one of the few independent evidence-based assessments of what ought to be covered, especially in the area of prevention, which Kennedy has made a priority.' 'Postponing the meeting makes me very nervous,' Caplan added. As health secretary, Kennedy does have the authority to remove and appoint new members of the committee, said Jen Kates, senior vice president and director of the Global Health & HIV Policy Program at KFF, a health policy research group. That authority was actually a factor in the Supreme Court's decision last month to uphold the Affordable Care Act provision that requires insurers to cover certain preventive services for free. The court agreed with the Trump administration that the task force members were 'inferior officers,' Kates said, because their work was directed and supervised by Kennedy. 'The Supreme Court basically ruled that the [health] secretary has the power to appoint members and remove them at will,' Kates said. 'So it basically affirms the argument that the secretary has the ultimate authority over the panel.' It's unclear which areas of health care Kennedy might target by shaking up the panel. PrEP, the HIV prevention pill, is 'one to watch,' Kates said, because the Trump administration has already moved to restrict access to the medication in other countries. Caplan said Kennedy could direct the task force to look into topics he's interested in, such as nutrition or processed foods. Health groups immediately pushed back when news broke that Kennedy postponed the meeting. On Wednesday, a letter signed by more than 100 public health groups — including the American Medical Association and the American Academy of Pediatrics — urged U.S. lawmakers to 'defend the task force's integrity.' The letter was led by AcademyHealth, a group representing health researchers. This article was originally published on
