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National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people


Chapter 15: Prevention and early detection of cancer
Prevention of lung cancer
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☰ Table of contents


Recommendations: Prevention of lung cancer

Preventive intervention type

Who is at risk?

What should be done?

How often?

Level/ strength of evidence

References

Screening

Asymptomatic adults, including people who smoke or who are ex-smokers Population-based screening of either high-risk or low-risk people with either chest X-ray or low-dose computed tomography (CT) is not recommended at this time.

Further evidence from screening studies in high-risk individuals may change this recommendation in the future
  IID 125–127

Behavioural

  Provide lifestyle risk factor counselling on the benefits of avoiding smoking and exposure to second-hand smoke (refer to Chapter 1: Lifestyle, ‘Smoking’) At least during annual health assessment; refer to Chapter 1: Lifestyle, ‘Smoking’ III–IIB

 


Background


Lung cancer is the most common cancer diagnosed in Aboriginal and Torres Strait Islander peoples, with an incidence rate two times that of non-Indigenous people, and a mortality rate that is 1.8 times higher. This is highly correlated with higher rates of smoking in Aboriginal and Torres Strait Islander populations compared to non-Indigenous populations.3

 

Interventions


Smoking cessation: Tobacco smoking is the major contributor to lung cancer. Smoking cessation and reducing exposure to second-hand smoke decreases the risk of developing lung cancer (refer to Chapter 1: Lifestyle, ‘Smoking’).

Neither low-dose CT scanning nor chest X-ray are currently recommended for population-based screening for lung cancer in Australia.125–127 One large randomised controlled trial from overseas found that screening people at high risk of lung cancer (people aged 55–74 years with a 30-year pack history of smoking and either currently smoking or ceased within the last 15 years) with low-dose CT reduces lung cancer mortality and, to a lesser degree, all-cause mortality.128 A meta-analysis of nine trials (including this trial), however, found a non-significant trend to reduced lung cancer mortality.128 However, there were methodological weaknesses in several of the trials included in these analyses, and further studies are underway.129 While lowdose CT scanning has been recommended by the US Preventive Services Task Force, the cost-effectiveness of implementing this screening strategy has not been assessed.130,131 The applicability of low-dose CT population-based screening for lung cancer in Australia is unknown at this stage and is not recommended at present in Australian guidelines due to the uncertainty of the target population, the health benefit versus harms, and the cost-effectiveness of this screening in the Australian population.127
 

National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people

 





 
 
  1. Australian Institute of Health and Welfare. Australian burden of disease study: Impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011. Canberra: AIHW, 2016.
  2. Cunningham J, Rumbold AR, Zhang X, Condon JR. Incidence, aetiology, and outcomes of cancer in Indigenous peoples in Australia. Lancet Oncology 2008;9(6):585–95.
  3. Australian Institute of Health and Welfare. Cancer in Australia 2017. Canberra: AIHW, 2017.
  4. Australian Institute of Health and Welfare. Australia’s health 2016. Canberra: AIHW, 2016.
  5. National Health and Medical Research Council. Prostate-specific antigen (PSA) testing in asymptomatic men. Canberra: NHMRC, 2013.
  6. Australian Technical Advisory Group on Immunisation. The Australian immunisation handbook. 10th edn. Canberra: Department of Health, 2015.
  7. Australian Institute of Health and Welfare. Cervical screening in Australia 2013–2014. Canberra: AIHW, 2016.
  8. Commonwealth Department of Health. National cancer screening register.[Accessed 8 February 2017].
  9. Coory MD, Fagan PS, Muller JM, Dunn NA. Participation in cervical cancer screening by women in rural and remote Aboriginal and Torres Strait Islander communities in Queensland. Med J Aust 2002;177(10):544–47.
  10. Binns PL, Condon JR. Participation in cervical screening by Indigenous women in the Northern Territory: A longitudinal study. Med J Aust 2006;185(9):490–95.
  11. Whop LJ, Garvey G, Baade P, et al. The first comprehensive report on Indigenous Australian women’s inequalities in cervical screening: A retrospective registry cohort study in Queensland, Australia (2000–2011). Cancer 2016;122(10):1560–69.
  12. Whop LJ, Baade P, Garvey G, et al. Cervical abnormalities are more common among Indigenous than other Australian women: A retrospective record-linkage study, 2000–2011. PLoS One 2016;11(4):e0150473.
  13. Gilles M, Crewe S, Granites I, Coppola A. A community-based cervical screening program in a remote Aboriginal community in the Northern Territory. Aust J Public Health 1995;19(5):477–81.
  14. Hunt JM, Gless GL, Straton JA. Pap smear screening at an urban aboriginal health service: Report of a practice audit and an evaluation of recruitment strategies. Aust N Z J Public Health 1998;22(6):720–25.
  15. Reath J, Carey M. Breast and cervical cancer in indigenous women-overcoming barriers to early detection. Aust Fam Physician 2008;37(3):178–82.
  16. Dorrington M, Herceg A, Douglas K, Tongs J, Bookallil M. Increasing Pap smear rates at an urban Aboriginal Community Controlled Health Service through translational research and continuous quality improvement. Aust J Prim Health 2015;21(4):417–22.
  17. Everett T, Bryant A, Griffin MF, Martin-Hirsch PP, Forbes CA, Jepson RG. Interventions targeted at women to encourage the uptake of cervical screening. Cochrane Database Syst Rev 2011;(5):CD002834.
  18. Services CDoH. Practice Incentives Program. 25 November 2016.  [Accessed 18 January 2017].
  19. Commonwealth Department of Health. National Cervical Screening Progam. Available at www.health.gov.au/internet/screening/publishing.nsf/Content/cervical-screening-1 [Accessed 18 January 2017].
  20. Cancer Council Australia. National Cervical Screening Program: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding.  [Accessed 20 April 2017].
  21. Commonwealth Department of Health. About the human papillomavirus (HPV) and cervical cancer.  [Accessed 18 January 2017].
  22. Commonwealth Department of Health. Immunise Australia Program.  [Accessed 18 January 2017].
  23. Australian Technical Advisory Group on Immunisation. Systematic review of the safety, immunogenicity and efficacy of HPV vaccines. Canberra: DoHA, 2007.
  24. Commonwealth Department of Health. Future changes to cervical screening.  [Accessed 18 January 2017].
  25. International Collaboration of Epidemiological Studies of Cervical Cancer. Comparison of risk factors for invasive squamous cell carcinoma and adenocarcinoma of the cervix: Collaborative reanalysis of individual data on 8097 women with squamous cell carcinoma and 1374 women with adenocarcinoma from 12 epidemiological studies. Int J Cancer 2007;120(4):885–91.
  26. UK National Screening Committee (UK NSC) recommendation on cervical cancer screening in women.  [Accessed 18 January 2017].
  27. Kitchener H. Advisory Committee for Cervical Screening: Report to the National Screening Committee 2015.
  28. Cancer Council Australia. Cervical cancer screening. Available at www.cancer.org.au/cervicalscreening [Accessed 16 January 2018].
  29. Appleby P, Beral V, Berrington de González A, et al. Carcinoma of the cervix and tobacco smoking: Collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies. Int J Cancer 2006;118(6):1481–95.
  30. Collins S, Rollason TP, Young LS, Woodman CBJ. Cigarette smoking is an independent risk factor for cervical intraepithelial neoplasia in young women: A longitudinal study. Eur J Cancer 2010;46(2):405–11.
  31. Australian Bureau of Statistics and Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2008. Canberra: ABS and AIHW, 2008.
  32. Parker C, Tong SY, Dempsey K, et al. Hepatocellular carcinoma in Australia’s Northern Territory: High incidence and poor outcome. Med J Aust 2014;201(8):470–74.
  33. The Kirby Institute. Bloodborne viral and sexually transmissible infections in Aboriginal and Torres Strait Islander people: Annual surveillance report 2016. Sydney: Kirby Institute, UNSW, 2016.
  34. Commonwealth Department of Health. Fourth National Hepatitis C Strategy 2014–2017. Canberra: DoH, 2014.
  35. World Health Organization. Hepatitis B vaccines: WHO position statement. WHO Weekly epidemiological record 2009;40(84):405–20.
  36. Commonwealth Department of Health. National Immunisation Program Schedule.  [Accessed 20 January 2017].
  37. Commonwealth Department of Health. Pharmaceutical Benefits Scheme: General statement for drugs for the treatment of hepatitis C. 2017.  [Accessed 20 January 2017].
  38. Chang MH, You SL, Chen CJ, et al. Long-term effects of hepatitis B immunization of infants in preventing liver Cancer. Gastroenterology 2016;151(3):472–80.
  39. Commonwealth Department of Health. Second national hepatitis B strategy 2014–2017. Canberra: DoH, 2014.
  40. Commonwealth Department of Health. Fourth national Aboriginal and Torres Strait Islander blood-borne viruses and sexually transmissible infections strategy 2014–2017. Canberra: DoH, 2014.
  41. National Institute for Health and Care Excellence. Hepatitis B (chronic): Diagnosis and management. London: NICE, 2013.
  42. Australasian Society for HIV medicine. Decison-making in HBV. Sydney: ASHM, 2013.
  43. Australasian Society for HIV medicine. Hepatitis B and primary care providers. Sydney: ASHM, 2012.
  44. Zhang BH, Yang BH, Tang ZY. Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol 2004;130(7):417–22.
  45. National Cancer Institute. Liver (hepatocellular) cancer screening. Bethesda, MD: NCI, 2010.
  46. Australasian Society for HIV medicine. Decision-making in viral hepatitis related advanced liver disease for primary care providers. Sydney: ASHM, 2015.
  47. Aghoram R, Cai P, Dickinson JA. Alpha-foetoprotein and/or liver ultrasonography for screening of hepatocellular carcinoma in patients with chronic hepatitis B. Cochrane Database Syst Rev 2012;(9):CD002799.
  48. Australasian Society for HIV medicine. Decision-making in HCV. Sydney: ASHM, 2016.
  49. Australasian Society for HIV medicine. Primary care providers and hepatitis C. Sydney: ASHM, 2016.National Institute for Health and Care Excellence. Cirrhosis in over 16s: Assessment and management. London: NICE, 2016.
  50. Bagnardi V, Blangiardo M, La Vecchia C, Corrao G. A meta-analysis of alcohol drinking and cancer risk. Br J Cancer 2001;85(11):1700–05.
  51. Peng L, Jiyao W, Feng L. Weight reduction for non-alcoholic fatty liver disease. Cochrane Database Syst Rev 2011;(6): CD14003619.
  52. Lok AS, McMahon BJ, Brown RS, et al. Antiviral therapy for chronic hepatitis B viral infection in adults: A systematic review and metaanalysis. Hepatology 2016;63(1):284–306.
  53. Australian Institute of Health and Welfare and Cancer Australia. Breast cancer in Australia: An overview. Canberra: AIHW and Cancer Australia, 2012.
  54. Australian Institute of Health and Welfare. BreastScreen Australia monitoring report 2013–2014. Canberra: AIHW, 2016.
  55. Cancer Australia. Advice about familial aspects of breast cancer and epithelial ovarian cancer: A guide for health professionals. Strawberry Hills, NSW: Cancer Australia, 2015.
  56. Cancer Australia. Familial Risk Assessment: FRA-BOC.  [Accessed 23 January 2017].
  57. Moyer VA. Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women: US Preventive Services Task Force recommendation statement. Ann Intern Med 2014;160(4):271–81.
  58. Hilgart JS, Coles B, Iredale R. Cancer genetic risk assessment for individuals at risk of familial breast cancer. Cochrane Database Syst Rev 2012;(2):CD003721.
  59. Siu AL. Screening for breast cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med 2016;164(4):279–96.
  60. Cancer Australia. Position statement: Early detection of breast cancer. Strawberry Hills, NSW: Cancer Australia, 2015.  [Accessed 23 January 2017].
  61. Gotzsche PC, Jorgensen KJ. Screening for breast cancer with mammography. Cochrane Database Syst Rev 2013;(6):CD001877.
  62. Mandelblatt JS, Cronin KA, Bailey S, et al. Effects of mammography screening under different screening schedules: Model estimates of potential benefits and harms. Ann Intern Med 2009;151:738–14.
  63. Independent UK Panel on Breast Cancer Screening. The benefits and harms of breast cancer screening: An independent review. Lancet 2012;380(9855):1778–86.
  64. Cancer Australia. Position statement: Overdiagnosis from mammographic screening. Strawberry Hills, NSW: Cancer Australia, 2014.  [Accessed 23 January 2017].
  65. Bonfill Cosp X, Marzo Castillejo M, Pladevall Vila M, Marti J, Emparanza J. Strategies for increasing the participation of women in community breast cancer screening. Cochrane Database Syst Rev 2001;(1):CD002943.
  66. Cancer Australia. MRI for high risk women.  [Accessed 23 January 2017].
  67. National Institute for Health and Care Excellence. Familial breast cancer: Classification, care and managing breast cancer and related risks in people with a family history of breast cancer. London: NICE, 2015.
  68. Kösters J, Gøtzsche P. Regular self-examination or clinical examination for early detection of breast cancer. Cochrane Database Syst Rev 2003;(2):CD003373.
  69. US Preventive Services Task Force. Screening for breast cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med 2009;151:716–26.
  70. Fitzgerald SP. Breast cancer screening: Viewpoint of the IARC Working Group. N Engl J Med 2015;373(15):1479.
  71. Hackshaw AK, Paul EA. Breast self-examination and death from breast cancer: A meta-analysis. Br J Cancer 2003;88(7):1047–53.
  72. Marjoribanks J, Farquhar C, Roberts H, Lethaby A, Lee J. Long-term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev 2017;1:CD004143.
  73. Commonwealth Department of Health. Pharmaceutical Benefits Scheme: Raloxifene.  [Accessed 23 January 2017].
  74. Cuzick J, Sestak I, Cawthorn S, et al. Tamoxifen for prevention of breast cancer: Extended long-term follow-up of the IBIS-I breast cancer prevention trial. Lancet Oncol 2015;16(1):67–75.
  75. Moyer VA. Medications to decrease the risk for breast cancer in women: Recommendations from the US Preventive Services Task Force recommendation statement. Ann Intern Med 2013;159(10):698–708.
  76. Cuzick J, DeCensi A, Arun B, et al. Preventive therapy for breast cancer: A consensus statement. Lancet Oncol 2011;12(5):496–503.
  77. Lostumbo L, Carbine NE, Wallace J. Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database Syst Rev 2010;(11):CD002748.
  78. National Breast and Ovarian Cancer Centre. Early detection of breast cancer: NBOCC position statement.  [Accessed October 10 2011].
  79. Cancer Council Australia. National cancer prevention policy 2007−09. Sy: Cancer Council Australia, 2007.
  80. Commonwealth Department of Health. BreastScreen Australia Program. Policy on screening women aged 40–49 years. Canberra: DoH, 2013.  [Accessed 16 January 2018].
  81. Australian Insititute of Health and Welfare. Cancer in Australia: An overview. Canberra: AIHW, 2014.
  82. Eliassen AH, Hankinson SE, Rosner B, Holmes MD, Willett WC. Physical activity and risk of breast cancer among postmenopausal women. Arch Intern Med 2010;170(19):1758–64.
  83. International Agency for Research on Cancer. World cancer report 2014. Geneva: World Health Organization, 2014.
  84. Gaudet MM, Gapstur SM, Sun J, Diver WR, Hannan LM, Thun MJ. Active smoking and breast cancer risk: Original cohort data and meta-analysis. J Natl Cancer Inst 2013;105(8):515–25.
  85. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and breastfeeding: Collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50,302 women with breast cancer and 96,973 women without the disease. Lancet 2002;360(9328):187–95.
  86. World Cancer Research Fund and American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: A global perspective. Washington, DC: AICR, 2007.
  87. Gramling R, Eaton CB, Rothman KJ, Cabral H, Silliman RA, Lash TL. Hormone replacement therapy, family history, and breast cancer risk among postmenopausal women. Epidemiology 2009;20(5):752–56.
  88. Australian Insititute of Health and Welfare. National bowel cancer screening program: Monitoring report 2016. Canberra: AIHW, 2016.
  89. Australian Institute of Health and Welfare and Department of Health and Ageing. National bowel cancer screening program: Annual monitoring report 2009. Canberra: AIHW, 2009.
  90. Bowel Cancer Screening Pilot Monitoring and Evaluation Steering Committee. The Australian bowel cancer screening pilot program and beyond: Final evaluation report. Canberra: Department of Health and Ageing, 2005.
  91. Christou A, Katzenellenbogen JM, Thompson SC. Australia’s national bowel cancer screening program: Does it work for Indigenous Australians? BMC Public Health 2010;10:373.
  92. Christou A, Thompson SC. How could the National bowel cancer screening program for Aboriginal people in Western Australia be improved? Report to the WA Bowel Cancer Screening Implementation Committee, Department of Health. Perth: Centre for International Health, Curtin University and Combined Universities Centre for Rural Health (University of Western Australia), 2010.
  93. Cancer Council Australia Colorectal Cancer Guidelines Working Party. Clinical practice guidelines for the prevention, early detection and management of colorectal cancer. Sydney: Cancer Council Australia, 2017.  [Accessed 9 January 2018].
  94. Australian Institute of Health and Welfare. Analysis of bowel cancer outcomes for the National bowel cancer screening program. Canberra: AIHW, 2014.
  95. Hewitson P, Glasziou P, Irwig L, Towler B, Watson E. Screening for colorectal cancer using the faecal occult blood test, Hemoccult. Cochrane Database Syst Rev 2007;(1):CD001216.
  96. Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA 2016;315(23):2564–75.
  97. Lin JS, Piper MA, Perdue LA, et al. Screening for colorectal cancer: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2016;315(23):2576–94.
  98. Holme Ø, Bretthauer M, Fretheim A, Odgaard-Jensen J, Hoff G. Flexible sigmoidoscopy versus faecal occult blood testing for colorectal cancer screening in asymptomatic individuals. Cochrane Database Syst Rev 2013;(9):CD009259.
  99. Commonwealth Department of Health. National bowel cancer screening program. [Accessed 30 January 2017].
  100. Cancer Council Australia. Understanding your FOBT. 2016. [Accessed 30 January 2017].
  101. Rothwell PM, Fowkes FG, Belch JF, Ogawa H, Warlow CP, Meade TW. Effect of daily aspirin on long-term risk of death due to cancer: Analysis of individual patient data from randomised trials. Lancet 2010;377(9759):31–41.
  102. Rothwell PM, Wilson M, Elwin CE, et al. Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials. Lancet 2010;376(9754):1741–50.
  103. Cuzick J, Thorat MA, Bosetti C, et al. Estimates of benefits and harms of prophylactic use of aspirin in the general population. Ann Oncol 2014;26(1):47–57.
  104. Bibbins-Domingo K, US Preventive Services Task Force. Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med 2016;164(12):836–45.
  105. Cole BF, Logan RF, Halabi S, et al. Aspirin for the chemoprevention of colorectal adenomas: Meta-analysis of the randomized trials. J Natl Cancer Inst 2009;101(4):256–66.
  106. Dubé C, Rostom A, Lewin G, et al. The use of aspirin for primary prevention of colorectal cancer: A systematic review prepared for the US Preventive Services Task Force. Ann Intern Med 2007;146(5):365–75.
  107. Barclay K, Cancer Council Australia Surveillance Colonoscopy Guidelines Working Party. Algorithm for colorectal cancer screening – Family history. Sydney: Cancer Council, 2013.
  108. National Institute for Health and Care Excellence. Colorectal cancer prevention: Colonoscopic surveillance in adults with ulcerative colitis, Crohn’s disease or adenomas. London: NICE, 2011.
  109. Cancer Council Australia Surveillance Colonoscopy Guidelines Working Party. Clinical practice guidelines for surveillance colonoscopy. Sydney: Cancer Council Australia, 2011.
  110. Rothwell PM, Wilson M, Elwin CE, et al. Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials. Lancet 2010;376(9754):1741–50.
  111. Burn J, Gerdes AM, Macrae F, et al. Long-term effect of aspirin on cancer risk in carriers of hereditary colorectal cancer: An analysis from the CAPP2 randomised controlled trial. Lancet 2011;378(9809):2081–87.
  112. Zeegers MPA, Jellema A, Ostrer H. Empiric risk of prostate carcinoma for relatives of patients with prostate carcinoma: A metaanalysis. Cancer 2003;97(8):1894–1903.
  113. Liede A, Karlan BY, Narod SA. Cancer risks for male carriers of germline mutations in BRCA1 or BRCA2: A review of the literature. J Cancer Res Clin Oncol 2004;22(4):735–42.
  114. Institute NC. Genetics of Prostate Cancer (PDQ®) – Health professional version.  [Accessed 24 January 2017].
  115. Bruner DW, Moore D, Parlanti A, Dorgan J, Engstrom P. Relative risk of prostate cancer for men with affected relatives: Systematic review and meta-analysis. Int J Cancer 2003;107(5):797–803.
  116. Prostate Cancer Foundation of Australia and Cancer Council Australia PSA Testing Guidelines Expert Advisory Panel. Clinical practice guidelines PSA testing and early management of test-detected prostate cancer. Cancer Council Australia. [Accessed 16 January 2018].
  117. Ilic D, Neuberger MM, Djulbegovic M, Dahm P. Screening for prostate cancer. Cochrane Database Syst Rev 2013;(1):CD004720.
  118. Hayes JH, Barry MJ. Screening for prostate cancer with the prostate-specific antigen test: A review of current evidence. JAMA 2014;311(11):1143–49.
  119. Chou R, Croswell JM, Dana T, et al. Screening for prostate cancer: A review of the evidence for the US Preventive Services Task Force. Ann Intern Med 2011;155(11):762–71.
  120. Commonwealth Department of Health, Standing Committee on Screening. Prostate cancer screening position statement.  [Accessed 16 January 2018].
  121. Public Health England. Prostate cancer risk management programme (PCRMP): Benefits and risks of PSA testing.  [Accessed 24 January 2017].
  122. Prostate Cancer Foundation of Australia and Cancer Council Australia. PSA Testing Guidelines Expert Advisory Panel. Clinical practice guidelines PSA testing and early management of test-detected prostate cancer. Sydney: Cancer Council, 2015.
  123. The Royal Australian College of General Practitioners. Patient information sheet: Should I have prostate cancer screening? East Melbourne, Vic: RACGP, 2015.  [Accessed 17 January 2018].
  124. Fong K, Cancer Council Australia Lung Cancer Prevention and Diagnosis Guidelines Working Party. Clinical practice guidelines for the prevention and diagnosis of lung cancer: In people at risk of lung cancer, does population based screening with chest radiography reduce mortality?  [Accessed 31 January 2017].
  125. Lau E, Cancer Council Australia Lung Cancer Prevention and Diagnosis Guidelines Working Party. Clinical practice guidelines for the prevention and diagnosis of lung cancer: In people at risk of lung cancer, does population based CT screening reduce mortality? Cancer Council Australia. [Accessed 31 January 2017].
  126. Commonwealth Department of Health, Standing Committee on Screening. Position statement: Lung cancer screening using low-dose computed tomography. Canberra: DoH, 2015.
  127. Manser R, Lethaby A, Irving LB, et al. Screening for lung cancer. Cochrane Database Syst Rev 2013;(6):CD001991.
  128. Fong K, University of Queensland. International Lung Screen Trial (ILST). CinicalTrials.gov, 2016.  [Accessed 17 January 2018].
  129. Fu C, Liu Z, Zhu F, Li S, Jiang L. A meta-analysis: Is low-dose computed tomography a superior method for risky lung cancers screening population? Clin Respir J 2016;10(3):333–41.
  130. Moyer VA. Screening for lung cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med 2014;160(5):330–38.
  131.  
  132.  
  133.  
  134.  
  135.  
  136.  
  137.