Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2026

Projected impact of low-dose CT lung cancer screening on radiotherapy demand and delivery in Australia: a novel modelling study (146284)

Fadi Maghak 1 2 , Vicky Chin 3 , Jessica Lin 2 3 , Anzela Anzela 2 3 , Michael Caruana 4 , Marianne Weber 4 , Geoff Delaney 2 3 5 , Shalini Vinod 2 3 5 , Mei Ling Yap 2 3 5 6
  1. School of Medicine, Western Sydney University, Campbelltown
  2. Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), The Ingham Institute for Applied Medical Research, Liverpool, NSW
  3. Liverpool and Macarthur Cancer Therapy Centre, South-western Sydney Local Health District, Liverpool, NSW
  4. Sydney School of Public Health, The University of Sydney, Sydney
  5. South-Western Sydney Clinical School, University of NSW, Sydney
  6. The George Institute for Global Health, UNSW Sydney, Barangaroo, NSW

The impact of Australia’s National Lung Cancer Screening Program (NLCSP) on oncological resource needs remains unknown. We estimated NLCSP impact on radiotherapy demand and technique, and surgical demand, to 2060. 

A stage-specific incidence, radiotherapy and surgical projection model was developed incorporating adjustments for screening-interval and double-counting bias, stage shift, and radiotherapy technique utilisation, alongside a comparative counterfactual no-screening model. Baseline incidence and stage distributions were derived from four Australian state registries, supplemented by national screening-eligibility projections, alongside international screening behaviours and outcomes as inputs. New South Wales, Queensland, Victoria, and Western Australia were independently modelled, and scaled nationally. Radiotherapy utilisation, including stereotactic ablative body radiotherapy (SABR), was modelled using a dynamic decision tree, with a sojourn-time model simulating screening. Outcomes included stage distributions, radiotherapy fractions, and demand for linear accelerators (LINAC), cardiothoracic surgeons (CTS) and radiation oncologists (RO). 

Stage distribution was projected to shift toward earlier-stage disease, from 26%, 8%, 18% and 48% (Stage I-IV) at baseline, to 35%, 8%, 18%, and 41%, by 2059-2060. National incidence was projected to reach 16,250 new diagnoses annually in 2025-26, increasing to 21,000 annual cases by 2059-2060. Radiotherapy fractions increased by 26% in 2025-26, then 15% on average, compared to no screening. By 2059-2060, SABR fractions reduced by 8-12% relative to no-screening, despite increasing in absolute number. In that same period, radiotherapy resource demand remained approximately 15-16% above the no-screening scenario, requiring four additional LINACs nationally. RO demand remained similar to the no-screening trajectory, while surgical demand increased by 28% in 2025-26. 

Lung cancer screening was projected to significantly increase radiotherapy fractions, LINAC and CTS demand, with minor impact on RO demand. SABR reductions likely reflect increased surgical management and fewer oligometastatic patients due to an earlier-stage shift. These findings warrant long-term workforce and infrastructure planning at both state and national levels.