Poster Presentation 2025 Joint Meeting of the COSA ASM and IPOS Congress

Modelling the reach of international lung cancer screening programs: a comparison of engagement strategies, eligibility criteria and access (126535)

Hannah Jongebloed 1 , Lan Gao 2 , Hua-Hie Yong 3 , Trish Livingston 4 , Victoria White 3 , Coral Gartner 5 , Geoffrey T Fong 6 7 8 , Andrew Hyland 9 , Katherine A East 7 10 , Ann McNeill 10 , Krzysztof Przewozniak 11 12 , Chang Bum Kang 13 , Ron Borland 3 , Witold Zatoński 14 , K. Michael Cummings 15 , Gil-yong Kim 13 , Vivienne Milch 16 , Anna Ugalde 1
  1. Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
  2. Deakin Health Economics, Institute of Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
  3. School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
  4. Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
  5. NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Herston, QLD, Australia
  6. Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
  7. School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
  8. Ontario Institute for Cancer Research, Toronto, Ontario, Canada
  9. Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
  10. Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
  11. Global Institute of Family Health, University of Kalisz, Kalisz, Poland
  12. Global Research, Implementation and Training Lab, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
  13. Office of Tobacco Control Policy, Korea Health Promotion Institute, Seoul, Republic of Korea
  14. Institute – European Observatory of Health Inequalities, University of Kalisz, Kalisz, Poland
  15. Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
  16. Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia

Objective/purpose: Given the challenges demonstrated in engaging eligible participants in lung cancer screening programs internationally, participation in screening must be optimised. This study compared the engagement strategies, eligibility criteria and estimated reach of lung cancer screening programs in Australia and 10 other countries.

Procedures: A policy landscape analysis and modelling the potential reach of lung cancer screening programs was undertaken. A model was developed using population data, smoking statistics and pilot study estimates of smokers meeting risk prediction model thresholds. Data from the International Tobacco Control Policy Evaluation Project was used to compute pack-years for current and past smokers. An estimate of the number of current smokers considered eligible for each country was calculated by applying their respective programs eligibility criteria.

Results: The policy analysis demonstrated that eight (73%) countries utilised pack-years to measure smoking intensity, with four countries adopting 30 pack years as an eligibility requirement. The remaining programs utilised risk prediction models to determine eligibility. Most programs (58%) did not have clear approaches or strategies to engage key population groups.

Modelling estimated that 1.6% of Australia's total population were eligible for lung cancer screening, reflecting current smokers who met the criteria. Eligibility in other countries ranged from 2.5% to 6.4% of the population, exceeding 5% in European countries (Czechia, Croatia, and Poland). Broader age ranges, lower pack-year thresholds, and higher smoking rates contributed to greater estimated program reach.

Conclusions: Australia’s lung cancer screening program is estimated to reach the smallest proportion of people compared to other programs internationally. As Australia’s program commences, maximising throughput will support improved lung cancer outcomes. Consideration of equitable access across key population groups should remain a priority, with few countries developing strategies for equitable access.  Expanding eligibility criteria for Australia’s program in future years could further reduce avoidable lung cancer deaths.