The first year of Australia’s lung cancer screening program has seen nearly 100,000 current and former smokers take up the offer of free low-dose CT screening. As a result, more than 230 primary lung cancers have been detected.

The program, which was launched on July 1, 2025, aimed to recruit people aged 50-70 years who were either current heavy smokers or had smoked heavily in the previous decade. These patients would undergo biennial CT scans.

Lung cancer is the most common cause of cancer death in Australia. It claimed more than 9000 lives in 2022, and around 15,500 new cases are diagnosed each year. Lung cancer is the fifth most common cancer diagnosis in Australia and the leading cancer diagnosis among Aboriginal and Torres Strait Islander Australians, who have a much lower 5-year survival rate from the disease compared with non-Indigenous Australians.

This program marks the first new cancer screening program introduced to Australia in 20 years. The last was the national bowel cancer screening program that began in 2006.

‘Equity at Its Core’

The speed with which the program was implemented surprised even those on the front line. The enquiry that first recommended the screening concluded as recently as 2020. “It’s the fastest to be delivered from ideation to implementation in the world,” said Mark Brooke, CEO of the Lung Foundation Australia, a not-for-profit organization focused on lung disease.

The program was set up with “equity at its core,” particularly for First Nations people and those living in rural and remote areas, Shalini Vinod, MD, radiation oncologist at the University of New South Wales in Sydney, Australia, told Medscape News Australia. “I think it’s novel…at trying to get the target population treated, getting the message out at all different levels: to the patients and families, the consumers, the general practitioners, the radiologists, and, of course, to the treating specialists as well,” she said.

The program was codesigned with the National Aboriginal Community Controlled Health Organisation (NACCHO), which represents Indigenous community health organizations around the country. “Strong uptake of lung cancer screening by Aboriginal and Torres Strait Islander people in the program’s first year is not a happy accident,” NACCHO CEO Dawn Casey said in a statement. “It is what happens when screening is built to be culturally safe, delivered through Aboriginal community-controlled health organizations, and backed by a growing Aboriginal and Torres Strait Islander cancer workforce.”

The referral pathway for screening starts within general practice, but one of the program’s innovations was to allow nurse practitioners, too, to refer patients for screening, Brooke said. “That’s thinking outside the box in terms of equity, in terms of rural and remote and isolated communities. Where you might not have a general practitioner, you can speak to a nurse practitioner,” he said.

Seeking Earlier Diagnosis

The uptake of screening among those referred has been around 96%, according to Brooke, but the high numbers haven’t overwhelmed the radiology workforce. “We’ve been able to pick up the capacity that was already within the system,” he said. “The radiology providers did a superb job in getting their teams ready, so it hasn’t added additional burden. What it’s done is use the existing infrastructure better.”

Bottlenecks in the pathway from screen-detected abnormality to diagnosis are still possible, said Vinod. “We had already identified that they are bottlenecks in terms of diagnostic workup, because you need access to PET scans, which are a little bit more limited, and then, of course, to biopsies,” she said. “We are already having difficulty coping with our current lung cancer workload, resulting in delays for some of these procedures.”

Nevertheless, the benefits for patients diagnosed at an earlier stage of disease could be significant, said Vinod. “At the moment, about 50% of patients with lung cancer are diagnosed with stage IV disease, which is incurable,” she said. “If we can change the stage distribution from stage IV to a bit more stage I and II, it’ll result in easier treatment, less costly treatment, shorter treatment, and then improve the survival rates and cure rates of lung cancer.”

Brooke and Vinod reported having no relevant financial relationships.