Brian Mitchell (Lyons, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on the National Cancer Screening Register Amendment Bill 2024. Strengthening Medicare and improving healthcare services is an absolute priority for the Albanese Labor government. In our first 23 months in office, we've made huge strides in building back the healthcare system that was so sadly neglected by those opposite. We've opened 58 urgent care clinics across Australia for non-life-threatening urgent care, including four in my home state of Tasmania. We've made the largest investment in bulk-billing in the proud 40-year history of Medicare. We've tripled incentives for GPs to bulk bill kids, pensioners and concession cardholders, delivering direct benefits to 11 million Australians. We've made the biggest reduction to PBS medicine prices since the scheme was introduced; thousands of Australians had been putting off getting the medicines they need, simply because they couldn't afford them, but we've made medicines cheaper, saving Australians $250 million in 2023 alone. We're also cutting the cost of more than 300 common medicines by allowing doctors to prescribe 60-day prescriptions, saving patients money and time. And we've brought in other bills to strengthen our healthcare system, with a plan to reduce nicotine addiction for Australians and, just this morning I spoke on extending the scope of practice for midwives and nurse practitioners.

When it comes nicotine addiction, our excise tariff amendments, which increase the tax on tobacco by five per cent for three years—in addition to the ordinary annual indexation—aims to reduce smoking rates to below 10 per cent by 2025 and, hopefully, to five per cent or less by 2030. And our government is tackling the insidious introduction and rapid rise of consumer vaping head-on. E-cigarettes and vapes have been sold to governments and communities around the world in the past decade as a therapeutic good; that they were a product that could help hardened smokers kick the habit. These are usually men and women in their 40s or 50s who are smoking a pack, or more than a pack, a day. Getting them onto vaping, e-cigarettes, instead was sold as a way to get people off the fags. But what we see now is a new generation taking up vaping up—kids. We see them every day in our streets, vaping, with lolly flavoured nicotine. It's an entirely new generation of nicotine dependency being born, and the biggest issue is absolutely with school-age children. If vapes are therapeutic goods, as they have been sold to us, then it is entirely appropriate that Australia should regulate them as therapeutic goods instead of allowing them to be sold in convenience stores, so often close to schools.

At the same time that all of this is going on, our government remains focused on increased education and support, and the 2023-24 budget included $63 million for public health information campaigns to discourage Australians from taking up vaping and smoking and to encourage more people to quit. We don't do this for the hell of it. We know that, when you smoke or when you vape, you increase your likelihood of getting illnesses and cancer. A further $30 million has also been invested in support programs to help Australians quit. These measures aim to address the significant threat to public health that is caused by cigarettes and vaping.

We want to do everything we can to avoid people suffering from preventable lung cancer. While advances have been made in the diagnosis, treatment and care of people with lung cancer, it remains the leading cause of cancer related deaths in this country. The 2023-24 federal budget provided $263.8 million for a new national lung cancer screening program, intended to commence in July 2025, to support earlier detection of lung cancer, when treatment is likely to be more effective. Compared to most other cancers, the survival rate of people with lung cancer remains poor. On average, only 20 per cent of people diagnosed with lung cancer survive five years after diagnosis, compared to a five-year survival rate of more than 70 per cent for all other cancers combined. Some of that's to do with the late diagnosis of lung cancer, when it has often spread throughout. But that's a big difference—a five-year survival rate of 70 per cent for other cancers and just 20 per cent for lung cancer.

Indigenous Australians are twice as likely to be diagnosed with lung cancer, compared to non-Indigenous Australians. They're also twice as likely to die from lung cancer, compared to the general population. When you look at smoking rates among Indigenous Australians, you can see the correlations.

In addition to Indigenous Australians, people living in remote and regional Australia and in areas of greatest socioeconomic disadvantage are disproportionately affected by lung cancer, with higher lung cancer incidence and mortality in these populations.

I'll just briefly touch on my own electorate, which had the unenviable record of having the highest smoking rates in the country in 2020. In a suburb in my electorate, Bridgewater, which is very socioeconomically disadvantaged, it's estimated that 40 per cent of the adult population smoke daily, and they're 3½ times more likely to die from smoking related illnesses. That compares to 14 per cent of the national population that smokes daily. Some people have a cigarette at a party; they call themselves social smokers. But 14 per cent of the national population smokes daily, compared to 40 per cent in that suburb in my electorate.

The estimated number of new cases of lung cancer in Australia in 2023 was more than 14,000, with lung cancer contributing to nine per cent of all new cancer cases diagnosed. We lost as many as 8,691 Australians to lung cancer last year, and, although age, working conditions and family history can contribute, smoking of nicotine products is the major contributor. On average, 350 Tasmanians a year are told they have lung cancer—not news you want to get—and Tasmania had the second-highest mortality rate in Australia for lung cancer in 2019. That's 33 per 100,000 people.

The new screening program this bill enables is expected to prevent more than 500 lung cancer deaths every year.

The National Cancer Screening Register Amendment Bill 2024 amends the National Cancer Screening Register Act 2016, which provides the legislative framework for the operation of the register. Specifically, the bill before the House today adds lung cancer to the definition of designated cancer and into coverage by the register. Currently, the designated cancers in the act are bowel cancer and cervical cancer. This allows the register to support the National Bowel Cancer Screening Program and the National Cervical Screening Program respectively. This bill provides the legislative basis for the register to deliver the NLCSP, including handling of program participants' personal and sensitive information in connection with lung cancer screening and diagnosis.

Adding lung cancer as a designated cancer will extend the existing protections in the act to lung cancer screening information held in the register. These protections include prohibiting the collection, use or disclosure of personal information in the register in connection with the NLCSP outside circumstances set out in the act. These limited authorisations ensure personal information is only collected, recorded, used or disclosed to or from the register for specific purposes. Adding lung cancer as a designated cancer in the act extends the existing data breach framework to an individual's lung cancer screening information held in the register. This includes requirements for notification and handling of contraventions and possible contraventions in relation to protected information.

While the bill is small, containing just two minor amendments, its impact will be substantial for people with lung cancer. The National Lung Cancer Screening Program focuses particularly on First Nations people and priority populations, including those living in rural, remote and very remote areas; people with disability; and culturally and linguistically diverse population groups. I will certainly make the case to see a focus on the program in suburbs in my electorate. The program is intended to commence in July 2025, and its aim is to reduce the burden of lung cancer in the community, including incidence of death, morbidity and mortality. It will facilitate this by detecting lung cancer earlier than would be the case in the absence of screening, thereby improving health outcomes: the earlier you know about it, the earlier you can treat it. The program will target asymptomatic individuals aged 50 to 70 years who have a history of cigarette smoking of at least 30-pack years and if an individual has a history of cigarette smoking but has quit within the past 10 years.

Inclusion of lung cancer as a designated cancer allows the National Lung Cancer Screening Program to be the third program to be delivered by the register, enabling the expansion of the purposes already in place for bowel and cervical screening programs. We have seen success with those programs, and we certainly hope to see that success replicated with lung cancer. As I said, the bill extends the protections in the act fo4r screening information. These include prohibiting the collection, use and disclosure of information.

The Albanese Labor government is absolutely committed to strengthening Medicare and to strengthening and improving health care across our nation. We've introduced so many new measures since we were elected to office in May 2022. We've delivered cheaper medicines and urgent care clinics; we've invested more in bulk-billing; and we've increased the scope of practice for nurse practitioners. I'm so proud of the work we're doing in health care; we're making health care more affordable and more widespread so that more Australians can stay well, and, if they're not well, to get better quickly. The Albanese Labor government is absolutely committed to strengthening Medicare, and this expansion of the National Cancer Screening Register to incorporate lung cancer screening will absolutely help to deliver better healthcare outcomes for all Australians and will keep more Australians alive for longer. I commend the bill to the House.

Michelle Ananda-Rajah (Higgins, Australian Labor Party) Share this | Link to 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.

Louise Miller-Frost (Boothby, Australian Labor Party) Share this | Link to this | Hansard source

The Australian National Cancer Screening Register is a world-first digital platform that saves Australian lives. Cancer is a sad fact of life and death in our modern societies, in part because we're living longer. We all know that, generally, the earlier a cancer is diagnosed, the more likely treatment will be successful. That can be difficult because cancer often doesn't become symptomatic until it's large enough to feel or of a size to start interfering with bodily functions, particularly for internal cancers such as lung cancer.

In this country we are lucky enough to have world-class screening programs including the National Cervical Screening Program and the National Bowel Cancer Screening Program. Fifteen-and-a-half-thousand people are told they have bowel cancer every year in Australia. Around 850 people are diagnosed with cervical cancer every year—a number likely to continue to fall with the introduction of the HPV vaccine. Around 15,000 people each year are also diagnosed with lung cancer in Australia, and of those about 90 per cent are tobacco related.

Lung cancer accounts for around 9,200 deaths each year in Australia—the highest number of deaths from any particular type of cancer. It has a 22 per cent five-year survival rate, which is really low. That means around one in five people survive five years, partly because it's diagnosed late with advanced cancer. Early detection can increase that five-year survival rate to around 67 per cent, and that's what we're trying to do. This is another step in the war on cancer—this time lung cancer.

In 2020 Cancer Australia produced a report on the feasibility of implementing a national lung cancer screening program in Australia, which recommended a targeted screening program for those with a risk factor of over 1.51 per cent. Cancer Australia estimated that, in the first 10 years of a targeted and risk based national lung cancer screening program, over 12,000 lung cancer deaths would be prevented and up to 500,000 quality-adjusted life years—QALYs—would be gained.

That brings us to the National Cancer Screening Register Amendment Bill 2024. This bill will amend the National Cancer Screening Register Act 2016 to add lung cancer in the definition of 'designated cancer' and in the coverage of the National Cancer Screening Register. The bill will provide the legislative basis for the register to deliver the National Lung Cancer Screening Program, including handling of program participants' personal and sensitive lung cancer screening information. While the bill is small, containing two minor amendments, its impact will be substantial.

The new screening program this bill enables is expected to prevent more than 500 lung cancer deaths every year. The program will target asymptomatic individuals aged 50 to 70 years with a history of cigarette smoking of at least 30 pack years, including former smokers who've quit within the last 10 years. The lung cancer screening program particularly focuses on priority populations, including First Nations people, people living in rural, remote and very remote areas, people with disability and culturally and linguistically diverse groups. They will be screened through a low-dose CT scan which will be non-invasive with no pain.

The program is intended to commence in July 2025. The aim of the program is to reduce the burden of lung cancer in the community, including the incidence of disease, morbidity and mortality. The program will facilitate this by detecting lung cancer earlier than would be the case in the absence of screening, thereby improving health outcomes. Earlier diagnosis means earlier treatment and means you're more likely to be dealing with smaller cancers and cancers that are less likely to have spread. Earlier diagnosis means a higher likelihood of survivability. Inclusion of lung cancer as a designated cancer in the act along with the existing bowel cancer and cervical cancer designations will enable the National Lung Cancer Screening Program to be the third national cancer screening program to be delivered by the register.

The bill will enable the expansion to the new program of the register's purposes that are already in place for the bowel and cervical screening programs. Importantly, adding lung cancer as a designated cancer will extend the existing protections in the act to lung cancer screening information held in the register. These protections include prohibiting the collection, use or disclosure of personal information in the register in connection to the National Lung Cancer Screening Program, outside of the circumstances set out in the act. These limited authorisations ensure that personal information is only collected, recorded, used or disclosed to or from the register for specific purposes.

A division having been called in the House of Representatives—

Sitting suspended from 11 : 15 to 11 : 47

Adding lung cancer as a designated cancer in the act will also extend the existing data breach framework to individuals' lung cancer screening information held in the register. This includes the requirements for notification and handling of contraventions and possible contraventions in relation to protected information.

This government is committed to strengthening Medicare, and this expansion of the national cancer screening program will help deliver better health outcomes for Australians. While prevention is best—and we have strategies to reduce smoking, as we have a bill currently in the House to reduce vaping—early intervention is next best, and this National Lung Cancer Screening Program is early intervention and it will save lives.

I commend the bill to the House.

Emma McBride (Dobell, Australian Labor Party, Assistant Minister for Mental Health and Suicide Prevention) Share this | Link to this | Hansard source

The National Cancer Screening Register Amendment Bill 2024 will amend the National Cancer Screening Register Act 2016 to add lung cancer to the definition of 'designated cancer' and to the coverage of the National Cancer Screening Register. The act provides a legislative framework for the operation of the National Cancer Screening Register, and it established the register as a repository of information about screening associated with certain types of cancer for the purpose of supporting cancer screening programs.

The register commenced operation in 2017. Since its commencement, the register has facilitated delivery of the National Bowel Cancer Screening Program and the National Cervical Screening Program. The addition of lung cancer as a designated cancer in the act will enable a third cancer screening program, the new National Lung Cancer Screening Program, to be delivered through the register from the program's commencement in July 2025. Importantly, by adding lung cancer as a designated cancer in the act, the bill will extend the scope of the register to screening and diagnosis associated with lung cancer screening. By extension, the bill will enable healthcare providers to access patients' lung cancer screening information to assist in their clinical decision-making, contributing to cancer detection, treatment and prevention in Australia. As a repository of lung cancer screening and diagnoses, the register will support the monitoring of the effectiveness, quality and safety of lung cancer screening to improve service delivery of the new program. From a privacy perspective, by adding lung cancer as a designated cancer, the bill will extend existing protections for participants' personal and sensitive information to the lung cancer screening information that will be held in the register.

This bill will serve to benefit the health of Australians by enabling support for lung cancer screening pathways, leveraged through the existing purposes of the register. The bill is small, containing two minor amendments. The program will have a positive impact on First Nations people and other priority populations disproportionately impacted by lung cancer, including those living in rural, remote and very remote areas, people with disability, and culturally and linguistically diverse population groups.

Lung cancer is still the leading cause of cancer related deaths in Australia and has a major impact on the Australian community in terms of morbidity and mortality. My nanna Elaine, who passed away 10 years ago, was successfully treated for lung cancer. With this new National Lung Cancer Screening Program, tens of thousands of Australians will benefit from early detection, treatment and, importantly, prevention. This bill, in supporting the implementation of the new program, is expected to prevent more than 500 lung cancer deaths every year.

Question agreed to.

Bill read a second time.

Ordered that this bill be reported to the House without amendment.