Michelle Ananda-Rajah (Higgins, Australian Labor Party) Share this | Hansard source

I rise to speak on the National Cancer Screening Register Amendment Bill 2024.

A diagnosis of cancer is devastating, but a diagnosis of lung cancer is particularly bad. Lung cancer five-year survival rates are currently 24 per cent, which is woeful. Really, they haven't moved much in decades. Around 1990, the five-year survival rate was 10 per cent. It's bumped up now to 24 per cent. That's still very bad.

Overwhelmingly, the biggest problem is a late diagnosis. Patients just present too late and they are diagnosed way too late. By then, the cancer has advanced. Eighty-five per cent of lung cancers are due to non-small cell lung cancer, things like adenocarcinoma. But then there is the much-feared small cell lung cancer, which affects 15 per cent of patients and has a propensity to disseminate, often at diagnosis. The treatments are no picnic. I have seen lots and lots of patients who have had lung cancer. In fact, I've diagnosed many cases myself. This has often been through incidental testing. A patient may come in through the hospital with an unrelated problem—say, pneumonia or chest pain—and they'll go through a battery of tests and a lesion, a spot, is found on the chest X-ray or the CT scan. Then one thing leads to another, maybe a fine-needle biopsy, where a needle is put in through the chest wall under CT, or it may be a bronchoscopy, where a camera is put down through the airway and then down deep into the lungs and a biopsy is taken. It's a fairly stressful period for patients when they know they may be walking around with a potential lung cancer. Then they have to undergo a series of tests and there is additional waiting. Then the histology has to be done and the pathology has to be looked at before a diagnosis is made. This is incredibly traumatic for patients. Then comes the sit-down with the oncologist, where the actual repertoire of tests and treatments are discussed with them. That may include surgery. Often surgery is required. It may include a lobectomy, where a lobe is taken out of a lung, or a wedge resection, where a piece of the lung is removed, or a pneumonectomy. I have seen that. That used to be done a while ago. That's where the entire lung is removed and essentially collapses down and that area becomes emptied and the other lung hyperexpands. Patients are not normal after this. They simply do not have the exercise and respiratory capacity. Then there's chemotherapy, there may well be radiotherapy and, nowadays, we also have access to immunotherapy.

The treatments are pretty serious, and patients struggle even getting through the treatments. They may not even necessarily have access to any of those treatments if their performance status is not good at the very beginning. In other words, you have to be able to walk and be self-caring in order to even be considered for certain types of chemotherapy. If you are not—and this is the case with many patients with lung cancer because they present so late and, by then, they are emaciated, they've lost weight, they're breathless and they're unable to walk a certain distance—at that stage the clinician may make a decision that you are not fit to undergo chemotherapy and you are then shunted down the palliative care route. That is an all-too-familiar pathway for patients with lung cancer.

We as a federal government want to change that. The Albanese government has an abiding commitment to pick up the baton that was passed to us from a previous government that took strong action on tobacco control. Australia once led the way on tobacco control. It was Nicola Roxon, a Labor health minister, who induced plain cigarette packaging in 2011. Then things went silent for a decade under the Liberals. We saw the ingress of vaping, e-cigarettes. We have seen a rise in nicotine dependency amongst particularly young people and some children as well. We currently have smoking rates that are stuck at around 11 per cent. We have adopted the National Tobacco Strategy. That was released in June of last year. That strategy lays out very clearly that we want to aim for smoking rates of 10 per cent or less by 2025. That's next year. Currently rates are 10.6, to be precise. We also want to get to smoking rates of five per cent or less by 2030. So we don't have a lot of runway, and we have a lot of public health work to do.

One of the key things we want to do is save lives in the interim. We are going to do that by introducing the National Lung Cancer Screening Program. Screening is familiar for cervical cancer and for bowel cancer. Lung cancer will now be added to the national register. This has come about thanks to tobacco excise duties, which will be paying for this world-leading initiative.

We have taken on board the advice from our medical advisory committee, so patients who have a long history of smoking, who have been heavy smokers—usually 30 pack years, which means one packet of cigarettes a day for 30 years—who are aged between 50 and 70 will have access to screening. That will be done through a low-dose CT scan of the chest. This is a non-invasive test. It is really no big deal. People lie in the machine, there is no contrast given, and they are in and out within minutes. There is no pain. It is very straightforward. In fact, it is easier in some respects than a chest X-ray, and it's a higher resolution test than a chest X-ray, so it will likely pick up any malignancies at an earlier stage.

Why is that important? The five-year survival rate for stage 1 lung cancer which is localised to the lungs—in other words, it hasn't spread to the lymph nodes, to the adjacent organs or to distant sites in the body—is actually 67 per cent. It's very high. It's completely different to the current five-year survival rate of 24 per cent. So we do want to pick these cancers up early.

The program will also be open to past heavy smokers—people have quit in the last 10 years. These patients will have access to a two-yearly—that's the recommendation at the moment—low-dose CT scan. We think that this will make a material difference. It will actually save lives. At the moment in Australia, there are around 15,000 new cases a year of lung cancer diagnosed, with a slight propensity towards men compared to women, and that results in around 8,700 deaths. So this screening program will save lives. That's the point of it. It will save lives and it will save patients from burdensome, toxic treatments, because it's so much easier to resect a nodule or blast it with radiotherapy than to go through arduous chemotherapy, which is pretty gruelling stuff.

We estimate that this screening program will prevent more than 500 lung cancer deaths per year. This is particularly important for vulnerable groups, priority groups in our community. I speak particularly of First Nations communities. In First Nations communities, smoking prevalence rates are up to 60 per cent. That's six times the national average. And we already know that our Indigenous brothers and sisters die on average eight to nine years before the rest of the population. Much of that is being driven by the harms associated with smoking.

Tobacco smoke contains over 7,000 toxins. Lung cancer is not the only health hazard associated with smoking. Smoking can actually trigger cancers in any part of the body. It is often seen in patients who are heavy smokers that they will have concurrent malignancies. They may have a head and neck cancer as well as a lung malignancy—or a bowel malignancy or a cervical malignancy and so on. It is incumbent upon us as a government to not drop the ball on this. I really hope we have bipartisan support on this, because it is in the interests of the nation that we drive down smoking rates.

For those people who, unfortunately, have been entrapped by the scourge of addiction, we want to make sure that they have access to the best available technology and that, if they are at risk of lung cancer, we pick this up early and we save their life. I wholeheartedly commend this no-brainer bill to the House. I am so proud of this Albanese government having brought forth this world-leading lung cancer screening program, as it will save lives.

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