Volume 199 - Issue 9
Should we screen for lung cancer in Australia?
Authors: Paul L R Mitchell and Thomas John
Med J Aust 2013; 199 (9): 586. || doi: 10.5694/mja13.11144
Published online: 4 November 2013
Published online: 4 November 2013
To the Editor: The United States National Lung Screening Trial demonstrated a 20% reduction in lung cancer deaths among smokers screened with three low-radiation-dose computed tomography scans at yearly intervals. Hew and colleagues recently outlined the challenges in implementing such a screening program in Australia.1 However, the potential for saving lives is enormous.
Currently only 14.1% of lung cancer patients survive 5 years - a marginal improvement ...
To the Editor: The United States National Lung Screening Trial demonstrated a 20% reduction in lung cancer deaths among smokers screened with three low-radiation-dose computed tomography scans at yearly intervals. Hew and colleagues recently outlined the challenges in implementing such a screening program in Australia.1 However, the potential for saving lives is enormous.
Currently only 14.1% of lung cancer patients survive 5 years — a marginal improvement from 8.7% over the period from 1982–1986 to 2006–2010.2 We estimate that the survival benefit of screening the approximately 80% of eligible smokers would push the 5-year survival rate from 14.1% to 29%. Screening beyond 3 years is likely to give even greater benefit.
A recent Victorian study indicated that 62% of smokers presenting with lung cancer had already quit smoking a median of 12 years earlier.3 The suggestion by Hew and colleagues that further smoking cessation measures are an alternative to screening would be of no benefit to those who, despite having quit, will get lung cancer over the next 10–20 years.
Measures to reduce smoking are essential, but are not an alternative to screening. Suggesting that they are is akin to saying that we shouldn’t screen for breast cancer in women taking hormone replacement therapy until it is no longer being used. This would prompt a general outcry from both the public and cancer specialists. It is also, unfortunately, another example of therapeutic nihilism in lung cancer. Uncertainty around the costs and benefits can be allayed by screening those at higher risk.4 Screening offers the only way to substantially alter survival in this disease over the next 10–20 years.
Competing interests
No relevant disclosures.
References
- Hew M, Stirling RG, Abramson MJ. Should we screen for lung cancer in Australia? Med J Aust 2013; 199: 82-83. 0_CBBGGDGI
- Australian Institute of Health and Welfare. Cancer survival and prevalence in Australia: period estimates from 1982 to 2010. Canberra: AIHW, 2012. (AIHW Cat. No. CAN65; Cancer Series No. 69.) http://www. aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737422721 (accessed Oct 2013).
- Mitchell PLR, Thursfield VJ, Ball DJ. Lung cancer in Victoria: are we making progress? Med J Aust 2013; 28 Oct [Epub ahead of print]. 0_CBBBCEBB
- Kovalchik SA, Tammemagi M, Berg CD, et al. Targeting of low-dose CT screening according to the risk of lung-cancer death. N Engl J Med 2013; 369: 245-254. 0_i1142874