The National Lung Cancer Screening Program (NLCSP) uses low-dose computed tomography (LDCT) scans to look for lung cancer in eligible asymptomatic high-risk people.
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People with symptoms suggestive of lung cancer should not be referred to the NLCSP. Instead, their symptoms should be investigated according to Cancer Australia’s guide for investigating symptoms of lung cancer.
NLCSP Guidelines
We are working with Cancer Australia to develop the NLCSP Guidelines to support the delivery of the NLCSP.
The guidelines will help healthcare providers:
- navigate the NLCSP with evidence-based recommendations along the screening pathway
- manage participants’ journeys through the screening program.
Cancer Australia has commissioned the University of Melbourne to develop the guidelines in consultation with experts, clinicians, researchers, Aboriginal and Torres Strait Islander peoples, and consumers.
The guidelines will include advice and recommendations developed based on existing evidence and materials, including the Medical Services Advisory Committee’s (MSAC) advice on a lung cancer screening program and assessment pathways.
The guidelines will include:
- steps of the screening and assessment pathway, including participant recruitment and eligibility
- information on providing smoking cessation advice and support
- the requirements for shared decision-making
- low-dose computed tomography (LDCT) referral, screening, and assessment
- recommendations and practice points
- links to existing diagnostic and management pathways, and guidelines, related to suspected lung cancer and for incidental findings.
Professional colleges and peak bodies are also working to prepare their sectors for the NLCSP launch, including developing specific materials that link to the program guidelines. For example, the Daffodil Centre will develop a suite of information materials for various audiences.
We expect the NLCSP Guidelines will be completed by late 2024, with consultation to occur throughout the development process.
New MBS items for NLCSP LDCT scans
Two new Medicare Benefit Schedule (MBS) items will be created to provide low-dose computed tomography (LDCT) scans under the NLCSP. The new MBS items are for:
- the screening LDCT scan done by the participant every 2 years
- the interval LDCT scans for any follow-up needed during the 2-yearly screening period (as required following results of the screening LDCT test).
These will be mandatory bulk billing items and will have mandatory reporting requirements.
From July 2025, the MBS website will provide more information on these new items, including the item descriptors and explanatory notes.
Consultation on the MBS item descriptors occurred with the National Aboriginal Community Controlled Health Organisation (NACCHO), Cancer Australia, professional colleges, peak bodies, the NLCSP Expert Advisory Committee, and state and territory governments from October 2023 to March 2024, with final Expert Advisory Committee review in June 2024.
Screening costs
The Medicare schedule fee for the 2 new MBS items will be based on the schedule fee for MBS item 56301 and standard indexation will apply. The NLCSP MBS items are exempt from the 2024–25 Budget measure to amend the schedule fee for certain CT items. MSAC set the criteria for the NLCSP MBS items.
Radiology providers must bulk bill LDCT scans for NLCSP when using the NLCSP-related MBS items above.
As a bulk-billed item, a radiology provider accepts the schedule fee as full payment for the service when claiming from MBS. This means patients will not have any out-of-pocket costs for the LDCT scan through the NLCSP.
Mandatory reporting
Structured radiology reporting is being developed to ensure a nationally standardised approach for radiologists to accurately and consistently report NLCSP LDCT scan results.
Reports for the person’s initial NLCSP scan and their subsequent scans will be read and reported using the ‘nodule management system’ recommended by MSAC.
Reporting initial scans
The program will use the Pan-Canadian Early Detection of Lung Cancer (PanCan) risk model for baseline scans (the initial scan when entering the screening program).
PanCan is a risk assessment tool based on patient and nodule characteristics that estimates the probability that a nodule from an LDCT scan is lung cancer.
PanCAN was selected as the baseline nodule management model based on clinical evidence and consultation, and because it has the highest sensitivity for baseline scans. PanCan has been internationally validated for use in baseline scans.
Reporting interval scans
The program will use the Lung CT Screening Reporting & Data System (Lung-RADS) for interval scans.
Lung-RADS is a quality assurance tool which standardises lexicon, interpretation, reporting and management of findings in lung cancer screening. Lung-RADS assists in nodule categorisation and will support healthcare providers in considering the next steps.
Healthcare providers will refer patients with low and medium risk for more frequent monitoring and will quickly work with patients with high risk.
You can read more about the required nodule management system in MSAC’s March–April 2022 Public Summary Document attachments.
We are working with Cancer Australia and the radiology sector to ensure this reporting supports the clinical needs of the program as well as the mandatory requirement for radiology providers to report to the NSCR.
Reporting to the National Cancer Screening Register
The National Cancer Screening Register (NCSR) provides a single electronic record for each person in Australia participating in the Australian Government’s National Bowel Cancer Screening Program and National Cervical Screening Program. The rules accompanying the National Cancer Screening Register Act 2016 will require radiologists to report NLCSP screening information to the NCSR.
Similar to the bowel and cervical screening programs, healthcare providers will access information in the NCSR through the Healthcare Provider home page and the Healthcare Provider Portal.
The NCSR provides information and helpful reminders about screening. See Accessing the National Cancer Screening Register for more information about what patients can use the portal for.
Healthcare providers may access participant information and remind them if they need to take action in relation to lung cancer screening.
The NCSR supports the delivery of the NLCSP by:
- maintaining a national database of lung screening records
- reminding participants when they are due or overdue for lung screening and when they need to take action after a scan
- providing participant lung screening reports to
- assist radiologists in reporting LDCT scans
- support healthcare providers in recommending follow-up investigations
- enabling participants to access their lung cancer screening information in the register, including updating their participation for example changing their communication preferences
- monitoring of the effectiveness, quality and safety of lung cancer screening to improve delivery of the NLCSP.
The program guidelines, along with workforce education and information materials, will help healthcare providers navigate through and provide information to the NCSR.
Data collection and clinical information software providers
The Australian Government operates the NCSR under strict protocols to ensure all personal information is safe.
In 2024, we will consult with stakeholders on the data to be collected for the NLCSP. Only data that supports a patient’s journey and participation in the program will be collected. The data collected will also help track the success of the program and identify ways to improve the delivery of the program to ensure better health outcomes.
The NLCSP will not require medical imaging providers to have any additional software to deliver the program. Work is underway to ensure the NCSR interacts and operates effectively with existing software. New structured reporting templates will be integrated into the current systems and push relevant information into the NCSR. We are engaging with radiology and general practice software vendors.
The LDCT scans of NLCSP participants will not be stored in the NCSR. However, all Australian governments are currently working together to develop national health information capabilities under the Intergovernmental Agreement on National Digital Health 2023–27. This will allow health professionals across different sectors to access key health information (including diagnostic images) about their patients in a timely way, regardless of where the information is stored.
Workforce education and information
We will provide workforce education and information materials for healthcare providers (in various formats) to support the delivery of the program. This includes information on:
- navigating the program pathway
- delivering the program
- supporting participants.
Cancer Australia has commissioned the Daffodil Centre to develop a suite of information materials for various audiences.
We will also tailor these materials to further support healthcare providers in delivering the program in a culturally appropriate way for Aboriginal and Torres Strait Islander peoples and other priority populations.
We will make workforce education and information materials available before the program launches to ensure the healthcare sector, and all professions along the screening pathway, are ready for July 2025.
Radiology sector materials
The radiography and radiology workforce has a specific and significant technical role in delivering the NLCSP. We will support this by developing radiology-specific information materials and workforce education resources in partnership with the radiology sector.
We are consulting the radiology sector throughout this process. Radiologists are represented in the NLCSP Expert Advisory Committee. We are keen to ensure the entire radiology sector is involved in the design and implementation of the program. Please contact us for more information.
We also provide updates to and seek feedback from our Diagnostic Imaging Stakeholder Committee. The Diagnostic Imaging Stakeholder Committee provides a forum for diagnostic imaging stakeholders, including industry, clinicians, and consumer representatives to share information and discuss issues relating to diagnostic imaging and the diagnostic imaging sector, including:
- diagnostic imaging policy and regulatory issues relating to Medicare
- changes and trends in the utilisation of diagnostic imaging services.
As the radiology workforce is an accredited and regulated workforce, there will be no further accreditation required to deliver the program.
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