STEP 1: Prevention and early detection

This step outlines recommendations for the prevention and early detection of lung cancer.

Evidence shows that not smoking, avoiding or limiting alcohol intake, eating a healthy diet, maintaining a healthy body weight, being physically active, being sun smart and avoiding exposure to oncoviruses or carcinogens may help reduce cancer risk (Cancer Council Australia 2018).

Recommendations for preventing lung cancer include the following:

  • Stop smoking. All patients who currently smoke (or have recently quit) should be offered best practice tobacco dependence treatment and an opt-out referral to a behavioural intervention service such as Quitline 13 78 48, and be prescribed smoking cessation pharmacotherapy, if clinically appropriate. Conversations about smoking can be framed using the Ask, Advise, Help model:
    • Ask all patients if they smoke and document the response in their medical record.
    • Advise all patients who smoke to quit in a clear, non-confrontational and personalised way, and advise of the best ways to quit.
    • Help all patients who smoke to quit by offering a referral for behavioural intervention (e.g. Quitline 13 78 48) and/or prescribing pharmacotherapy (e.g. nicotine replacement therapy).
  • Avoid exposure to second-hand tobacco smoke. Smoking cessation care should be offered to the patient’s partner (and significant others) who smoke.
  • Prevent occupational exposure to asbestos, silica, radon, heavy metals, diesel exhaust and polycyclic aromatic hydrocarbons (Malhotra et al. 2016).
  • Take regular, moderate- to vigorous-intensity physical activity (Moore et al. 2016)

The risk factors for developing lung cancer include:

  • lifestyle factors
    • physical inactivity (Moore et al. 2016)
  • environmental factors
    • second-hand smoke
    • occupational exposure to arsenic, polycyclic aromatic hydrocarbons, cadmium, radon, asbestos, silica, iron and steel founding, nickel, beryllium, chromium VI, paint or diesel exhaust
    • air pollution
  • personal factors
    • current or former tobacco smoking
    • increasing age
    • family history of lung cancer
    • personal history of cancer (e.g. lung cancer, head and neck cancer, bladder cancer)
    • chronic lung disease, such as chronic obstructive pulmonary disease (COPD) or pulmonary fibrosis.

Variations in lung cancer outcomes exist across populations:

  • Indigenous Australians are approximately twice as likely to be diagnosed with and to die from lung cancer and have a lower five-year survival compared with non-Indigenous Australians (AIHW 2018b; NCCI 2019b).
  • Incidence and mortality increase with remoteness (NCCI 2019b).
  • Incidence and mortality rates are highest for those living in lowest socioeconomic areas (NCCI 2019b).

Additionally, 25 per cent of lung cancers are not attributable to tobacco smoking, with a large proportion of lung cancer in Asian women occurring in never-smokers (Ha et al. 2015; Sun et al. 2007). A clear risk factor is not defined.

Increasing use of CT scans has led to increased detection of incidentally detected lung nodules, which should be managed according to existing guidelines (Cancer Australia 2020b).

There is currently no national screening program for lung cancer in Australia (Standing Committee on Screening 2015; Wade et al. 2018). The role of low-dose CT screening for lung cancer has been shown to be effective in reducing lung cancer mortality in asymptomatic people; however, its role for screening in Australia is currently being investigated. See Cancer Australia’s ‘Lung Cancer Screening enquiry’ for information and regular updates on the potential role of screening for asymptomatic patients.