Proposed Lung Cancer Screening Program “Complex Arrangements”

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RACGP is said to be “carefully” supporting lung cancer screening programs in high-risk populations. Latest submission To the Medical Services Advisory Board (MSAC).


To support the early detection of lung cancer National Lung Cancer Screening Program (NLCSP) uses low-dose tomography (LDCT) to assess high-risk individuals such as smokers and ex-smokers.


Screening is done every two years for program participants or until lesions that require management are identified. All participants will also need an LDCT referral form completed by a GP or other qualified practitioner.


In response to the proposal, the university is calling for a carefully considered, step-by-step implementation approach that involves general practice, which is the “major entry route” to the program.


“The benefits of screening depend heavily on identifying the appropriate high-risk target population and the specificity of the screening tool,” writes Dr. Karen Price, President of RACGP.


“By incorporating risk assessment tools into the general practice, we can systematically identify at-risk populations.”
However, while RACGP widely supports the program, it is unclear who will carry out the LDCT risk calculation, consent, and referral process, and how to cover the costs of providing these services. I am concerned that it is.


RACGP Expert Committee – Professor Mark Morgan, Chair of Quality Care, said: newsGP Although he favors NLCSP, introducing a new screening program is a “very complex task”.


‘NLCSP considered various components of the implementation [and] This adds to the complexity, “he said.


“Lung cancer screening is complicated by the need to make the program accessible to urban, rural and remote people. People with mental illness, Aboriginal and Torres Strait Islanders, CALD. It should be accessible to groups of people with high smoking rates. [culturally and linguistically diverse] group.


The second step in the screening process is the LDCT scan, which requires patients to make shared decisions, informed consent, and referrals.


“This makes the placement much more complicated than receiving an intestinal cancer screening kit at the post.”


Professor Morgan also suggested that the proposed model of using a separate risk calculator to determine patient suitability should be incorporated into general practice software so that it can be used seamlessly within a normal workflow. It states that it means something.


“To identify potential participants, it takes time to perform a risk assessment and then engage in a shared decision to see the scan,” he said.


‘It is much better to set the expectation at this stage that the scan is likely to show some anomalies. The same people at risk for lung cancer are at risk for COPD, cardiovascular disease, and other cancers.



Concerns about overdiagnosis
In addition to providing information on the benefits of the program, university submissions provide a clear overview of the harm that may result from engaging in screening, such as patient consent and information, such as the possibility of overdiagnosis. “Do”.


According to Professor Morgan, the LDCT step of the proposed screening pathway is “probably the most difficult” and reflects the RACGP submission requesting further clarification of the pathway for managing contingent findings.


“All contingent findings require a clear control path, and there is a great risk that some of these findings will lead to a cascade of further investigations,” he said.


“Most LDCT scans show some abnormalities, which can be thyroid nodules, adrenal nodules, coronary artery calcification, or lung pathology.


‘Approximately 11% of scans have nodules that require an early follow-up scan, and some require a biopsy. All of this is very destructive and anxious for those who are waiting for results.


“Some people will discover cancer of the thyroid gland that would never have caused harm in their lifetime. This kind of overdiagnosis was disastrous and wasteful abroad.


The RACGP submission states that a continuous assessment of NLCSP should be adopted to monitor overdiagnosis by positively comparing the mortality rates of the screened and unscreened populations.


“Reducing overall mortality and diagnosing lung cancer earlier than more successful treatment is a commendable goal,” said Professor Morgan.


“We need to design and prepare educational resources and public relations campaigns. Not only do we need to provide CT scans, but we also need to have the physical infrastructure to manage the results of those scans.


“That’s why RACGP recommends a gradual rollout of screening programs.”


On the other hand, if NLCSP is implemented, Professor Morgan also wants to see a Medicare-funded extension. Health Assessment – ​​Currently targeted at people over the age of 75 – For young patients for regular and comprehensive preventive health examinations.


He said such an extension would ensure all national screening programs and recommendations within. Red book It can be implemented using a “planned and proactive team-based approach”.


In addition, Professor Morgan states that the implementation of NLCSP not only increases the number of people receiving cancer treatment, but also makes cancer survivors in need of help.


“We know how important it is to help people in this situation,” he said.


“It will be important to build the ability to support survivors of all types of cancer.”



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Cancer screening LDCT lung cancer Overdiagnosis Preventive health

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