Which Patients Should Be Screened for Lung Cancer?

This information is intended for healthcare professionals.

Australia’s National Lung Cancer Screening Program gives GPs a clear framework for identifying patients who may benefit from low-dose CT screening, with the program intended for asymptomatic people at higher risk of lung cancer, based on age and smoking history.

GPs identify eligible patients, request LDCT screening where criteria are met, review results and coordinate follow-up. But where screening identifies a suspicious lung nodule or lesion, LDCT findings can guide referral for respiratory, oncology or cardiothoracic specialist assessment.

This update covers which patients should be considered for lung cancer screening, how eligibility applies in practice and when findings indicate referral for thoracic surgical opinion.

Referral to Mr Adrian Pick may be considered where LDCT or follow-up imaging identifies a suspicious lung lesion, suspected lung cancer or requires thoracic surgical assessment in Melbourne.

Who Is Eligible for Lung Cancer Screening?

Under Australia’s National Lung Cancer Screening Program, patients may be eligible if they meet all of the following criteria:

• Aged 50 to 70 years
• No signs or symptoms suggestive of lung cancer
• Currently smoke tobacco cigarettes or quit within the past 10 years
• Have a tobacco cigarette smoking history of at least 30 pack-years

A pack-year is calculated by multiplying the number of cigarette packs smoked per day by the number of years smoked. One pack per day for 30 years is 30 pack-years. Two packs per day for 15 years is also 30 pack-years.

GPs are well placed to identify eligible patients during chronic disease reviews, preventive health checks, smoking cessation consultations and reviews for respiratory or cardiovascular comorbidity.

How Screening Fits into the Referral Process

Low-dose CT screening is arranged by the GP or another eligible healthcare provider and performed by a radiology provider. The results are then reviewed in general practice, with follow-up guided by the radiology report and the National Lung Cancer Screening Program protocol.

Most screening findings will not require surgery. Some patients may need interval imaging, diagnostic CT, PET-CT, respiratory review or biopsy consideration.

Where imaging raises concern for lung cancer, resectability or the need for operative tissue diagnosis, referral for cardiothoracic specialist assessment may be indicated. In this setting, the LDCT report, prior imaging, smoking history, pulmonary function and comorbidity profile all help inform Mr Adrian Pick’s assessment and treatment planning.

Other Symptoms and Risk Factors

The national program criteria are based on age, smoking history and asymptomatic status. Other symptoms and risk factors should still influence clinical judgement and patient discussion as outlined.

Symptoms	Risk Factors
Persistent or changing coughHaemoptysisUnexplained shortness of breathUnexplained weight lossChest painRecurrent or non-resolving respiratory infectionHoarseness or persistent voice change	COPD or emphysemaFamily history of lung cancerOccupational exposure to asbestos, silica or diesel exhaustRadon exposurePrevious cancer historyAboriginal and Torres Strait Islander status, where smoking-related disease burden and access barriers may affect engagement

These factors do not replace program eligibility criteria, but support a more detailed risk discussion and a lower threshold for investigation where symptoms or concerning imaging findings are present. If imaging identifies a suspicious lesion, refer for specialist assessment.

What Low-Dose CT Screening Involves

Low-dose CT provides detailed lung imaging using a lower radiation dose than standard diagnostic CT. It is used to identify suspicious pulmonary nodules or early lung cancers before symptoms develop.

Many nodules found on LDCT are benign. For this reason, standardised radiology reporting and clear follow-up recommendations are important.

Two Medicare items support LDCT under the program:

• MBS item 57410 for the screening low-dose CT scan, generally performed approximately every two years
• MBS item 57413 for interval low-dose CT where follow-up is required after previous imaging

These items are mandatory bulk billed under the program.

Screening Intervals and Follow-Up

Routine screening is generally every two years for eligible participants with very low-risk findings. If a nodule or other finding requires closer surveillance, the radiology report will guide the timing of interval LDCT or further assessment. Follow-up may involve:

• Repeat low-dose CT at a shorter interval
• Diagnostic CT or PET-CT
• Respiratory physician review
• Biopsy consideration
• Lung cancer multidisciplinary team discussion
• Cardiothoracic surgical assessment where operative biopsy or resection is being considered

The GP role remains central including explaining results, coordinating follow-up, confirming attendance, supporting smoking cessation and referring into specialist care when findings require further assessment.

Discussing Screening with Patients

A screening discussion should cover the potential benefits and limitations of LDCT. Useful points to discuss include:

• LDCT may detect lung cancer before symptoms develop
• Not all nodules found on LDCT are cancer
• False positives and negatives can occur
• Incidental findings may lead to repeat imaging, procedures or separate follow up
• Screening does not replace smoking cessation, and support is available

As we all know, it is about informed participation. Patients should understand that screening can support earlier detection, but it does not rule out all lung cancers and may lead to further investigations.

Clinical Implications for GP Practice

GP involvement is a necessity to the success of lung cancer screening, with responsibilities including:

• Identifying eligible patients aged 50 to 70
• Calculating pack-year smoking history
• Confirming the patient is asymptomatic
• Discussing the benefits and limitations of LDCT screening
• Requesting screening through the national program where eligible
• Reviewing and explaining results
• Coordinating interval imaging or specialist referral where required
• Supporting smoking cessation and risk-factor management
• Referring suspicious or high-risk findings for specialist review

For patients who undergo LDCT, the screening report becomes an important part of the clinical record. If referral is needed, the LDCT findings, interval imaging, prior CT scans, respiratory history and smoking history can all support specialist assessment.

When to Refer for Specialist Thoracic Assessment

Consider referral for cardiothoracic specialist review when screening or follow-up imaging identifies:

• Enlarging pulmonary nodule
• Nodule with high-risk CT features
• PET-avid lesion
• Suspected or confirmed lung malignancy
• Lesion requiring tissue diagnosis
• Patient who may be suitable for surgical resection
• Complex imaging findings requiring multidisciplinary planning

Mr Adrian Pick provides specialist assessment in Melbourne for patients with lung nodules, suspected lung cancer and thoracic conditions where surgical opinion may be required. Assessment considers the patient’s LDCT and follow-up imaging, staging, pulmonary function, comorbidities and suitability for biopsy, resection or other management options.

GPs and other specialists can refer patients to Mr Adrian Pick for expert assessment and clear communication that supports ongoing care.

References:

Australian Government Department of Health, Disability and Ageing. (2026). How the National Lung Cancer Screening Program works. https://www.health.gov.au/our-work/nlcsp/how-it-works

Cancer Australia. (2026). Screening. https://www.canceraustralia.gov.au/cancer-types/lung-cancer/screening

Cancer Council. (2025). Optimal care pathway for people with lung cancer. Quick reference guide. https://www.cancer.org.au/assets/pdf/ocp/lung-cancer-quick-reference-guide

Leong, T. L., Siemienowicz, M., & Brims, F. J. H. (2025). Screen-detected and incidentally detected lung nodules: A guide for GPs. Respiratory Medicine Today, 10(1), 30–32. https://respiratory.medicinetoday.com.au/system/files/pdf/RMT2025-04-030-LEONG.pdf

Medicare Benefits Schedule. (2025). Item 57410 & Associated Notes IN.2.3. https://www9.health.gov.au/mbs/fullDisplay.cfm?q=57410&qt=item&type=item

This article is intended for healthcare professionals and provides general educational information to support referral decision-making in cardiothoracic care. It is not a substitute for independent clinical judgement or specialist medical advice. Mr Adrian Pick MBBS, FRACS | Gen Surg, FRACS | Cardiothoracic (MED0001117736) is a Cardiothoracic Specialist based in Melbourne, Australia.