Australia’s National Lung Cancer Screening Program (NLCSP) commenced on 1 July 2025. It uses low-dose CT (LDCT) to detect lung cancer earlier in people at high risk who do not have symptoms. Lung cancer causes more cancer deaths than any other cancer in Australia.
- Who should be screened
- Eligible people must meet all of the following:
- age 50–70 years
- no signs or symptoms suggesting lung cancer
- currently smoke tobacco cigarettes or quit within the past 10 years
- smoking history of ≥30 pack-years.
- Family history, occupational exposure or other lung cancer risk factors do not substitute for the program eligibility criteria.
- Once enrolled, smoking history eligibility does not need to be reassessed.
- A participant can therefore remain in the program even when it becomes >10 years since they quit smoking.
- Participants age out when they turn 71 years.
- Eligible people must meet all of the following:
- Pack-years
- Pack-years = packs smoked per day × years smoked
- For the program, 1 pack = approximately 20 cigarettes.
- Examples:
- 20 cigarettes/day × 30 years = 30 pack-years
- 40 cigarettes/day × 15 years = 30 pack-years
- 10 cigarettes/day × 60 years = 30 pack-years.
- Smoking histories are often approximate; use the patient’s best history and clinical judgement.
- For expanded detail: Smoking History
- Screening test
- Screening is with low-dose CT chest.
- Routine screening is approximately every 2 years if no finding requires earlier follow-up.
- The screening LDCT is free through Medicare for eligible people.
- MBS 57410 = routine screening LDCT.
- MBS 57413 = interval LDCT required because of a previous screening finding.
- These imaging items are mandatory bulk billed.
- Symptoms are not screening
- Do not send symptomatic patients through the screening pathway.
- Important symptoms include:
- persistent unexplained cough
- haemoptysis
- unexplained shortness of breath
- other symptoms or signs suspicious for lung cancer.
- These patients require diagnostic investigation, irrespective of whether they otherwise meet NLCSP eligibility criteria.
- Eligibility is not the same as suitability
- An eligible patient must also be able to undergo LDCT.
- Screening may need to be deferred or reconsidered if:
- unable to lie flat for approximately 5 minutes
- symptomatic respiratory infection within the previous 12 weeks
- full diagnostic chest CT within the previous 12 months
- another chest CT is planned for clinical reasons within the next 3 months
- severe comorbidity means investigation or treatment of a detected cancer would be inappropriate.
- Suitability may be temporary.
- What happens after the LDCT
- Management follows the NLCSP Nodule Management Protocol.
- At baseline:
- very low risk → repeat LDCT in 24 months
- low risk → 12 months
- low–moderate risk → 6 months
- moderate risk → 3 months
- high / very high risk → respiratory physician or other specialist linked to a lung cancer MDT.
- Clinically important incidental findings are managed according to the relevant clinical pathway.
- Smoking cessation
- A person does not have to stop smoking to participate in screening.
- Smoking cessation support should nevertheless be offered throughout the screening pathway.
- Screening is not a substitute for smoking cessation.
- For expanded detail: Smoking Cessation Medications
- Benefits and harms
- LDCT can detect lung cancer at an earlier, more treatable stage.
- Potential harms include:
- false-positive findings
- incidental findings
- additional CT scans
- invasive investigations
- radiation exposure
- overdiagnosis
- anxiety.
- This is why the program is targeted to people at sufficiently high risk, rather than offered as general population screening.
The useful exam skeleton is
- 50–70
- Asymptomatic
- Current smoker or quit ≤10 years
- ≥30 pack-years
- → LDCT every 2 years
- Symptoms → diagnose, don’t screen
- Abnormal LDCT → 12 / 6 / 3 months or respiratory MDT depending on risk
- And:
- Pack-years = (cigarettes/day ÷ 20) × years