Attitudes towards Lung Cancer Screening in an Australian High-Risk Population

Objectives. To determine whether persons at high risk of lung cancer would participate in lung cancer screening test if available in Australia and to elicit general attitudes towards cancer screening and factors that might affect participation in a screening program. Methods. We developed a 20-item written questionnaire, based on two published telephone interview scripts, addressing attitudes towards cancer screening, perceived risk of lung cancer, and willingness to be screened for lung cancer and to undertake surgery if lung cancer were detected. The questionnaire was given to 102 current and former smokers attending the respiratory clinic and pulmonary rehabilitation programmes. Results. We gained 90 eligible responses (M:F, 69:21). Mean [SD] age was 63 and smoking history was 32 pack years. 95% of subjects would participate in a lung cancer screening test, and 91% of these would consider surgery if lung cancer was detected. 44% of subjects considered that they were at risk of lung cancer. This was lower in ex-smokers than in current smokers. Conclusions. There is high willingness for lung cancer screening and surgical treatment. There is underrecognition of risk among ex-smokers. This misperception could be a barrier to a successful screening or case-finding programme in Australia. 1. Introduction There is considerable interest in the potential of lung cancer screening using low-dose CT scans to detect nodules that might be lung cancer early, at a treatable time point. Annual spiral CT screening detects lung cancers that are curable [1]. Whilst smaller randomised studies have not shown reduction in mortality, the largest performed to date, the US National Lung Cancer Screening Trial (NLST), showed reduction in both lung cancer specific and total mortalities [2] and has led to recommendations in favour of screening in the USA [3]. If these data are confirmed with other studies presently in progress, the case for CT screening implementation will further strengthen. These programs are perhaps more aptly called case detection, rather than screening, as the intervention is targeted at individuals at high risk. The key factors that were used to select patients for inclusion in the research screening programs were age and cumulative smoking history with prolonged period since smoking cessation as an exclusion criterion [2, 4]. Inclusion criteria could be further refined in order to limit the number of subjects screened and increase the rate of cancer detection. The effectiveness of screening will be highly dependent on personal risk recognition by those in