The "Max Up" lung cancer screening trial led by A/Prof Henry Marshall and colleagues has received MRFF funding. Starting in 2023, this 3 year research project will help ensure lung cancer screening delivers the best health outcomes to people at risk of lung cancer, by detecting lung cancer early, and giving people the greatest chance to quit smoking.
Lung cancer screening using computed tomography (LCS) can reduce lung cancer mortality by 20-24% and is now implemented in the US and a few other nations. In Australia, LCS is poised to become the fourth National cancer screening program following the highly positive recommendations of Cancer Australia’s 2020 report and Federal budget inclusion 2021/22.
Important implementation questions remain. Two of the most pressing are:
1) How do we best reach the target population?
People who smoke are at highest risk of lung cancer and stand to gain most from screening. However, they are less likely to engage with screening than people who do not smoke, or who formerly smoked. Maximising engagement with the target population is fundamental to LCS success.
2) How do we best integrate smoking cessation with lung cancer screening?
Quitting smoking for seven years has the same lung cancer mortality benefit as screening for three years. Smoking cessation is an important driver of lung cancer screening cost-effectiveness. Screenees who smoke may be more motivated to quit than their general population counterparts, but the most effective way to use this ‘teachable moment’ is unclear. Maximising smoking cessation outcomes is fundamental to LCS success.
The "Max Up" research project will be testing the integration of smoking cessation with lung cancer screening and aims to investigate the effectiveness and cost-effectiveness of:
- recruiting people at high-risk of lung cancer for LCS via Quitline
- intensive tailored quit support vs standard care on smoking outcomes amongst lung cancer screening participants.
This important work will inform models of care that will impact lung cancer screening and smoking cessation policy in Australia and internationally. Ultimately, this will maximise the health benefits of LCS and smoking cessation for hundreds of thousands of Australians and millions of people worldwide who are at risk of lung cancer by implementing an evidence-based, scalable pathway that is equitable, broad-reaching, cost-effective, acceptable to patients, and integrated into health practice via Quitlines.
