Now, the big question is no longer whether screening is a good idea. It is whether the health system can follow through after the screening results.
As I’ve written about before, there are issues with the process of how patients are followed up and treated, and with having enough staff to safely guide them through this critical time.
Without addressing these and other concerns, the program will find early lung cancers without delivering the full benefit Australians were promised.
Remind me, what’s lung cancer screening?
The National Lung Cancer Screening Program uses low-dose CT scans to look for lung cancer in high-risk people without symptoms.
It is aimed at people aged 50–70 who currently smoke, or have quit in the past ten years, with a smoking history of at least 30 pack-years (for example, one pack a day for 30 years).
The logic is straightforward: find lung cancer earlier, where there is a good chance of a cure and reduce deaths from a disease that remains Australia’s leading cause of cancer deaths.
The need for lung cancer screening is clear. Lung cancer causes more deaths than breast and bowel cancer combined. In 2025 more than 15,000 Australians were diagnosed with it. Early detection can shift more people into the stage where curative treatments, such as surgery, are possible.
Shortage of staff, and unequal access to services
But screening is only the front door. Once someone has an abnormal scan, the system needs enough staff, specialist services and coordination to move quickly from suspicion of lung cancer to diagnosis to treatment. That is where the risk lies.
Australia still has gaps in lung cancer services. This includes shortages of specialist nurses, incomplete specialist teams and uneven access to diagnostics and personalised medicine to treat the cancer.
A recent survey showed only four in ten institutions reported having the recommended core workforce for multidisciplinary lung cancer team meetings. This is where multiple members of a person’s health-care team meet to create and review their treatment plan.
Around one in four institutions lacked specialist lung cancer nurses. This matters because these nurses help coordinate care, explain test results and keep people moving through a complicated pathway.
The shortage of staff and services is felt most sharply outside major cities. The same survey found gaps in thoracic surgeons, nuclear medicine specialists and access to personalised molecular testing, particularly in non-metropolitan centres.
For patients in regional and remote areas, that can mean more travel, longer waits and a slower route to treatment. Screening may be national, and is even more accessible with mobile screening being rolled out in regional and rural areas. But lung cancer care is still too often determined by postcode.
This matters especially for Aboriginal and Torres Strait Islander peoples, who carry a disproportionate burden of lung cancer. We’ve long known this group is more likely to be diagnosed with it, and die from it, than non-Indigenous Australians.
The screening program was co-designed with Cancer Australia and the National Aboriginal Community Controlled Health Organisation, which is a strong start. But equity will only be real if access is culturally safe, follow-up is timely and Aboriginal community-controlled services are properly supported to deliver services.
How about quitting smoking?
There is also a missed opportunity to combine screening with more support to quit smoking.
There are important short- and long-term benefits of giving up smoking around the time of screening, a time when people are most open to quitting.
The screening program encourages clinicians to support participants to quit. However, there is no Medicare Benefits Schedule item number to support and fund this. So health professionals may be less likely to properly support people to quit smoking at the time of screening.
Are services working well? We just don’t know
Australia also needs better nationally collected data to tell us where clinical services are working well and where improvements are needed.
Right now, different hospitals across different jurisdictions use multiple different indicators of quality, so we cannot compare them. This data also doesn’t allow for the near-real-time feedback needed to improve care across the health system.
So it’s hard to tell whether the screening program is narrowing health equity gaps as it is designed to do, or simply revealing them earlier.
If these gaps are not addressed, the likely result will be more detection of early-stage lung cancer, but ongoing delays in accessing services and treatments. We’ll continue to see fragmented, poorly coordinated care across multiple health care providers and avoidable differences in outcomes and survival.
Fraser Brims, Professor, Curtin Medical School, Curtin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
