Academic literature on the topic 'Australia Military policy History'

ABSTRACTThe role of decolonization in the decline of the British empire has received a great deal of attention. In comparison there has been little research or analysis of the process of dedominionization affecting Australia and the other dominions. During the Second World War economic ties were seriously weakened and there were substantial conflicts over economic policy between the British and Australian governments. Australia refused to reduce imports in order to conserve foreign exchange, thus contributing to the United Kingdom's debt burden. The Australian government insisted that the British guarantee Australia's sterling balances and refused to adopt the stringent fiscal policies requested by the Bank of England and the British treasury. Australia also took the opportunity to expand domestic manufacturing industry at the expense of British manufacturers. Economic separation and conflict were complemented by political and strategic differences. In particular, the Australian government realized that British military priorities made it impossible for the United Kingdom to defend Australia. This led the Australians towards a policy of cooperating with the British embargo on Japan, only to the extent that this would be unlikely to provoke Japanese military retaliation. In general, the Australians preferred a policy of compromise in the Far East to one of deterrence preferred by the British.

This article draws on previously classified Australian and British archival material to reevaluate Australian Prime Minister Gough Whitlam's foreign policy. The article focuses on the Whitlam government's decision in 1973 to withdraw Australian forces from Malaysia and Singapore—a decision that constitutes a neglected but defining episode in the evolution of Australian postwar diplomacy. An analysis of this decision reveals the limits of Whitlam's attempt to redefine the conduct of Australian foreign policy from 1972 to 1975, a policy he saw as too heavily influenced by the Cold War. Focusing on Whitlam's approach to the Five Power Defence Arrangement, this article contends that far from being an adroit and skillful architect of Australian engagement with Asia, Whitlam irritated Australia's regional allies and complicated Australia's relations with its immediate neighbors. Australia's subsequent adjustment to its neighborhood was not the success story implied in the general histories of Australian diplomacy. Whitlam's policy toward Southeast Asia, far from being a “watershed” in foreign relations, as often assumed, left Australia increasingly isolated from its region and more reliant on its chief Cold War ally, the United States.

Australia is the leading country in the South Pacific and sees it as part of a natural sphere of influence. For most of Australian history, a remote and isolated geographical location has worked to the benefit of the Fifth Continent and has ensured the security of Australia and its Oceania frontiers. Nowadays, the strategic environment in Asia-Pacific has undergone significant changes. Australia is concerned that during the intensive growth of the military power of the People's Liberation Army of China (PLA), Beijing may be more interested in the South Pacific, in particular, in gaining naval bases in Oceania.

Working from recently declassified Australian and British government files, this paper examines the archival evidence on policy thinking in London and Canberra towards the Five Power Defence Arrangements (FPDA) during the period 1970–75. The article argues that one of the main reasons for the Heath government's decision to deploy a token military force in Southeast Asia as part of a multilateral defence arrangement with Australia, New Zealand, Malaysia and Singapore was the desire to uphold these Commonwealth connections. By contrast, Canberra was beginning to question the value of such arrangements in a rapidly changing Southeast Asian strategic environment.

This survey of books in English on North Korea, 1997–2007, identifies nearly 240 titles—mostly by US authors but also by authors in Australia, Europe, Japan, the Republic of Korea, and Russia. The books fall into eleven categories: history and culture; the Korean War revisited; the DPRK regime and its leaders; human rights and humanitarian issues; the economy: Juche, Songun, collapse, or reform; DPRK military assets and programs; relations with the United States; arms control negotiations and outcomes; regional and world security; prospects for North-South unification; and North Korea's future. A final section includes useful websites. This survey points to a wide interest in North Korea and underscores the serious and ongoing efforts of many scholars and policy analysts to understand developments there.

The article studies the history and the current stage of Russia’s aggression to-wards countries with lower military potential. The collapse of the post-war system of international relations and collective security has become apparent: the aggression of Russia against Moldova, Georgia and Ukraine has testified to the fact that there are no longer any tools to protect countries subjected to discrimination from super powers. Today discrimination affects not only people or social groups, but also some countries. Such countries are not capable of pursuing an independent policy as to major centres of international power they have to deal with. Peculiar to these countries are uncompetitive economy, low quality of life and undeveloped civil society, they hence become a target for “vital interests”, namely bidding by so-called super powers. “Giants” are attracted by the geographical location of a possible “victim”, access to the sea, transit facilities, natural resources, especially energy, low-cost labour, etc. It is often that “discriminated” countries become grounds for ignition of burning or frozen conflicts provoked by powerful neighbours’ influence, or are exposed to open aggression and become subject to occupation or hybrid war. This has all started after the Second World War, when super powers of the USSR and China, on the one hand, and the United States, Great Britain, Australia, and others, on the other, have made Korea fall into two states. In addition, there was subsequently a division of Germany, the Caribbean crisis…However, such conflicts then were not that wide-ranging, since the post-war collective security system was quite effective. Things, though, have changed dramatically in recent decades. One of the largest global players − Russia – has decisively begun to create around itself a buffer zone formed of countries, where it fuels frozen conflicts and in such a way keeps them under the radar and hinders their integration into the Western world. Initially, Russia ignited a conflict in Nagorno-Karabakh, supporting Armenia and assisting it to invade a considerable part of the territory in Azerbaijan, and then initiated the war in Transnistria by virtually occupying part of Moldova’s territory and asserting itself there on the pretext of deploying a peacekeeping mission. Later, there was a war in Abkhazia and then − in South Ossetia aiming to detach part of Georgia’s territory. And lastly, the turn of Ukraine has come… Regrettably, Ukraine is a typical and another example of a country that has fallen victim of multifaceted interests of the leading global players − Russia, the United States and the EU, and has faced all possible forms of discrimination. Keywords: war in eastern Ukraine, military aggression, geopolitics, conflicts, buffer zones.

This thesis is concerned with the conjunction of two themes. The first is the new tempo of Australia's security relationship with Japan. Since the late 1980s, governments in Canberra and Tokyo have increasingly called for greater partnership in pursuing shared security interests in the Asia-Pacific theatre. This development has been largely a result of the rise of Japan as a major international power, and a corresponding revival of doubts about the role of the US, hitherto the predominant power in the region. These questions about Australia's strategic environment have been thrown into sharp relief by the second theme of the thesis - the impact of the end of the Cold War on the international and regional order. The forces that precipitated the Cold War's demise, and its after effects, have raised fundamental questions about the international system, not least being for Australia, its future security environment and defence ties. This thesis, therefore, focuses on the intersection of emerging trends in one of Australia's major bilateral relationships and in the strategic order. The thesis is accordingly divided into two elements: an examination of the evolution of Australia-Japan ties and the recent development of defence links, and an analysis of the key systemic forces which will influence the future development of these links.

This thesis analyzes the military history of the Boiotian League during the Hellenistic period (338-200 BC). It argues that Boiotia experienced a large population increase in the fourth century BC followed by a steady population decline throughout the next two centuries caused primarily by environmental collapse. During the late Classical period (490-338 BC), one of the Boiotian League's primary focuses was protecting its plentiful population and agricultural land through an extensive network of fortifications. After the defeat they suffered in the battle of Chaironeia in 338 BC, the Boiotians became vulnerable to attack, and their federal government no longer possessed the resources to maintain this extensive defensive system. The Boiotian League then began to move towards more flexible modes of defense, but this proved too little too late when the Aitolian League inflicted a major defeat on the ill-prepared Boiotians in 245 BC. This forced the government into reforming its military on the model of the Makedonian army and instituting a rigorous training regimen for all Boiotian troops. The environmental and demographic decline occurring at this time drove many Boiotians to poverty, however, and many poor farmers were unable to spare the time to undergo intensive training during the second half of the third century BC. The Boiotian military thus became smaller, more professionalized, better coordinated, and ultimately better able to defend the large territory under the League's control. This allowed the federal government to face foreign threats with a flexible and dynamic defensive force despite the crisis of declining arable land and population it faced at this time.
Cette thèse analyse l'histoire militaire de la Confédération béotienne cours de la époque hellénistique (338-200 av. J.-C.). Il fait valoir que Béotie connu une croissance démographique importante dans le quatrième siècle av. J.-C. suivie d'un déclin de sa population au cours des deux siècles suivants causés principalement par l'effondrement de l'environnement. Au cours de la dernière époque classique (490-338 av. J.-C.), l'une des principale de la Confédération béotienne se concentre protéger sa population a été abondante et les terres agricoles à travers un vaste réseau de fortifications. Après la défaite qu'ils ont subie dans la bataille de Chéronée en 338 av. J.-C., les Béotiens sont devenus vulnérables à l'invasion, et le gouvernement fédéral ne possédait plus les moyens d'entretenir ce vaste système défensif. La Confédération béotienne a alors commencé à se déplacer vers des modes plus souples de la défense, mais cela s'est avéré trop peu trop tard quand la Confédération aitolienne infligé une défaite majeure sur les Béotiens mal préparés en 245 av. J.-C. Cela a forcé le gouvernement à réformer son armée sur le modèle de l'armée macedonienne et en instituant un régime d'entraînement rigoureux pour toutes les troupes béotiens. La dégradation de l'environnement et démographiques se produisent à l'heure actuelle conduit de nombreux Béotiens à la pauvreté, cependant, et de nombreux paysans pauvres n'ont pas pu trouver le temps de suivre une formation intensive au cours de la seconde moitié du IIIe siècle av. J.-C. L'armée béotienne est ainsi devenu plus petit, plus professionnalisée, mieux coordonnée, et finalement mieux à même de défendre le vaste territoire sous le contrôle de la Confédération. Cela a permis au gouvernement fédéral de faire face aux menaces étrangères ayant une force souple et dynamique défensive malgré la crise des terres arables diminue et la population qu'elle fait face en ce moment.

This thesis is about the importance of nuclear weapons to Australian defence and strategic policy in Southeast Asia between 1953 and 1973. It argues that Australia's approach to nuclear issues during this period, and its attitude towards the development and acquisition of nuclear weapons in particular, was aimed exclusively at achieving narrowly defined political objectives. Australia was thus never interested in possessing nuclear weapons, and any moves seemingly taken along these lines were calculated to obtain political concessions - not as part of a 'bid' for their acquirement. This viewpoint sits at odds with the consensus position of several focused studies of Australian nuclear policy published in the past decade. Although in general these studies correctly argue that Australia maintained the 'nuclear weapons option' until the early 1970s, all have misrepresented the motivation for this by contending that the government viewed such weapons in exclusively military terms. The claim that Australia was interested only in the military aspect of nuclear weapons does not pay due attention to the fact that defence planning was based entirely on the provision of conventional forces to Southeast Asia. Accordingly, the military was interested first and foremost with issues arising from extant conventional planning concepts, and the government was chiefly concerned about obtaining allied assurances of support for established plans. The most pressing requirement for Australia therefore was gaining sway over allied countries. However, the Australian government was never in a position to overtly influence more powerful allies against an undertaking that could escalate into limited war, and was similarly incapable of inducing its allies to retain forces in the region in spite of competing pressures. It was for this reason that Australia would seek to manipulate the nuclear weapons option. Indeed, access to such weapons offered Australia the opportunity to achieve greater integration in formulating allied planning, while the threat to manufacture them provided a means of convincing regional partners to maintain a presence in the area. The thesis therefore concludes that Australia carefully presented its options for procuring nuclear weapons to gain influence over its allies in response to strategic developments in Southeast Asia.

This dissertation argues that the experiences of a highly specific group of female medical personnel and the representations of their experiences, both during World War II and in the immediate postwar era, provide a unique opportunity for investigating the role of Australian women in the Pacific War, as well as the processes through which personal testimonies are produced in relation to collective memory, state-sponsored rituals of commemoration, and history. Victims of one of the most infamous war crimes of World War II, the Australian Army Nursing Service (AANS) Sisters and their wartime experiences at the hands of the Japanese Imperial Army (JIA) on Sumatra have been accorded considerable prominence in Australian narratives of the Pacific conflict. Yet notwithstanding this attention, there has been surprisingly little focus on the nurses’ own accounts of the episode. This dissertation is the first attempt to redress the balance by offering a critical reassessment of the original source material, while exploring the broader discursive contexts within which such accounts were produced. The dissertation considers first-hand accounts of the “Bangka Island Massacre” and the AANS Sisters’ subsequent internment by the Japanese between February 1942 and September 1945. The chapters that follow explore the role of the nurses’ ordeal on Sumatra in the development of a professional Australian nursing self-identity, the episode’s incorporation in the national rituals of commemoration surrounding the remembrance of the Pacific conflict, and ultimately, the extent to which the nurses’ narratives have fed into – and helped to shape – a distinctive postwar Australian nationalism. Even before their release from captivity, the AANS Sisters had acquired iconic status in Australia, as embodiments of heroic resistance, altruistic sacrifice and bravery. The dissertation is arranged in four thematic chapters, which consider four distinct areas of the nurses’ experiences – the “Bangka Island Massacre”, internment, press representation and remembrance. Chapter 2 reassesses documentary material collected for the International Military Tribunal for the Far East (IMTFE) in 1946 in order to examine the murders on Bangka Island and the alleged sexual violence associated with the crime. Chapter 3 draws on the published and unpublished camp memoirs of several of the nurses to explore the ways in which the nurses characterized their internment experiences, and the possible factors influencing the construction of those narratives. Chapter 4 makes use of Australian print and broadcast media archives to investigate how the imprisoned Sisters, and civilian and military nurses more generally, were portrayed by the press, and the possible effect this may have had on postwar nation-building, nationalism and remembrance in Australia. Finally, Chapter 5 examines the inclusion of the AANS Sisters in postwar commemorative endeavours and rituals of remembrance – including monuments, shrines, museum displays, temporary exhibitions and the celebration of Anzac Day – investigating the extent to which the nurses have been incorporated into the “Anzac legend”, Australia’s militaristic interpretation of the national character.
published_or_final_version
History
Master
Master of Philosophy

History
Ph.D.
The Canadian Militia, since its beginning, has been underfunded and under-supported by the government, no matter which political party was in power. This trend continued throughout the interwar years of 1919 to 1939. During these years, the Militia's members had to improvise a great deal of the time in their efforts to attain military effectiveness. This included much of their training, which they often funded with their own pay. They created their own training apparatuses, such as mock tanks, so that their preparations had a hint of realism. Officers designed interesting and unique exercises to challenge their personnel. All these actions helped create esprit de corps in the Militia, particularly the half composed of citizen soldiers, the Non-Permanent Active Militia. The regulars, the Permanent Active Militia (or Permanent Force), also relied on their own efforts to improve themselves as soldiers. They found intellectual nourishment in an excellent service journal, the Canadian Defence Quarterly, and British schools. The Militia learned to endure in these years because of all the trials its members faced. The interwar years are important for their impact on how the Canadian Army (as it was known after 1940) would fight the Second World War. To put it simply, the interwar years forced the Militia to focus on officer, NCO, and specialist development, creating a highly trained and effective nucleus of key personnel. This leadership core led Canada's land-based contribution to the war effort. Another important factor in the Canadian Army's performance was the Militia's interwar interest in mechanization, which revealed a remarkably progressive strain in this neglected organization.
Temple University--Theses

History
Ph.D.
Prior to World War II, the typical American Soldier was young and unmarried. As the old saying in the service went: if they wanted you to have a wife, they would have issued one to you. Today’s servicemember is most likely married and we customarily thank our military families in the same breath as those who wear the uniform. This dissertation is the story of how “support our troops” came to encompass the broader community of military families and how this fundamentally changed the military. Rooted in cultural and gender history, my dissertation argues that changing gender roles in the domestic sphere (i.e., fatherhood, motherhood, breadwinner, and homemaker) had a profound impact on martial roles in the military world, and vice versa. In the postwar era, as domestic roles were beginning to change, more and more married men enlisted in the Army and the Marine Corps, forcing the services to craft policies to accommodate families. Large numbers of married men in uniform was a new development in the United States, and my dissertation shows how marriage transformed civil-military relations. My dissertations addresses questions that are crucial to both the history of the military as well as American cultural life in the second half of the twentieth century. Just as military life became more family friendly, and as the services expanded opportunities for women, far fewer Americans overall chose to share in the burden of national service. Although military policymakers crafted policies to make military life more attractive, they contributed to its further isolation from the broader population by providing generous social services for military families increasingly inaccessible to other American families. Embedded within these contradictions is the story of what it meant to be an American after the Vietnam War.
Temple University--Theses

Historical analyses of soldiers in the Australian Imperial Force (AIF) during the Great War have focused overwhelming on combat experiences and the environment of the trenches. By contrast, little consideration has been made of the non-combat experiences of these individuals, or of the time they spent behind the front lines. Far from military experiences revolving around combat and trench warfare, the letters, diaries, and memoirs of working class men suggest that daily life for the rank and file actually revolved around work, and in particular manual labour. Through a focus on working class men???s experiences in the AIF during the Great War, this dissertation seeks to discover more about these experiences with work in an attempt to understand the broader aspects of life in the military. In this environment of daily work, many working class men also came to approach military service as a job of work, and they carried over the mentalities of the civilian workplace into their daily life in the military. This dissertation thus seeks to understand how workplace cultures were transferred from civilian workplaces into the military. It explores working class men???s approaches towards daily work in two different theatres of war, Gallipoli and the Western Front, in order to highlight the significance of work within military life. Furthermore, it evaluates aspects of this workplace culture, such as relations with employers, the use of workplace skills, and the implementation of industrial relations methods, to understand the continuities between the lives of civilians and soldiers. Finally, this dissertation is not a military history: it adopts a culturalist approach towards the lives of people in the AIF, and in the environment of the Great War, in an effort to place the military experiences of these working class men within the context of their broader civilian lives.

Today the Malay language is known to have communities of speakers outside the Malay archipelago, such as in Australia inclusive of the Christmas Islands and the Cocos (Keeling) Islands in the Indian Ocean (Asmah, 2008), the Holy Land of Mecca and Medina (Asmah et al. 2015), England, the Netherlands, France, and Germany. The Malay language is also known to have its presence on the Asian mainland, i.e. Thailand, Cambodia, and Vietnam. As Malays in these three countries belong to a minority, in fact among the smallest of the minorities, questions that arise are those that pertain to: (i) their history of settlement in the localities where they are now; (ii) the position of Malay in the context of the language policy of their country; and (iii) maintenance and shift of the ancestral and adopted languages.

This paper examines renewable energy developments on Aboriginal lands in North-West Western Australia at three scales. It first examines the literature developing in relation to large scale renewable energy projects and the Native Title Act (1993)Cwlth. It then looks to the history of small community scale standalone systems. Finally, it examines locally adapted approaches to benefit sharing in remote utility owned networks. In doing so this paper foregrounds the importance of Aboriginal agency. It identifies Aboriginal decision making and economic inclusion as being key to policy and project development in the 'scaling up' of a transition to renewable energy resources in the North-West.

There is a fraught history to the relationship between creative industries on the one hand and innovation and entrepreneurship policy and programs on the other. Such policy and program frameworks have rarely been inclusive of creative industries... This is, however, what we see happening in South Australia.

Professor Leslie R. Marchant was a Western Australian historian of international renown. Richly educated as a child in political philosophy and critical reason, Marchant’s understandings of western political philosophies were deepened in World War Two when serving with an international crew of the merchant navy. After the war’s end, Marchant was appointed as a Protector of Aborigines in Western Australia’s Depart of Native Affairs. His passionate belief in Enlightenment ideals, including the equality of all people, was challenged by his experiences as a Protector. Leaving that role, he commenced his studies at The University of Western Australia where, in 1952, his Honours thesis made an early case that genocide had been committed in the administration of Aboriginal people in Western Australia. In the years that followed, Marchant became an early researcher of modern China and its relationship with the West, and won respect for his archival research of French maritime history in the Asia-Pacific. This work, including the publication of France Australe in 1982, was later recognised with the award of a French knighthood, the Chevalier d’Ordre National du Mèrite, and his election as a fellow to the Royal Geographical Society. In this festschrift, scholars from The University of Notre Dame Australia appraise Marchant’s work in such areas as Aboriginal history and policy, Westminster traditions, political philosophy, Australia and China and French maritime history.

The aim of the article. One of the most interesting and topical problems in the USSR military industry development is the establishment and development of the USSR ammunition industry. The article is devoted to the study of one of the reasons for the poor supply of the Red Army by ammunition in the initial period of the war of 1941 - a lack of sleeves, which limited the production of artillery shells. The author sets the purpose of revealing the reasons for the unsatisfactory state of affairs in the field of manufacture by the industrial enterprises of the USSR industrial enterprises before the war, as well as the influence of this factor on the production and use of the sleeves during the war years. Methodology. General principles of historism and objectivity are the theoretical-methodological base of this work. Author also uses special historical methods: logic, systematic, chronological, actualisation and periodizing. Results. This article is based on documents storing in the Russian State Archive and Russian State Economical Archive. With the help of this documents and materials the author make the following decision: in 30th years of XX century in the USSR under forcing of industrial development the governmental bodies were not able to perform the efficient planning policy in the field of enterprises control especially in the defense branches. High-level personnel purposively disturbed technological process. It spoiled enterprises operation and it was the reason of defect production manufacturing. Practical application. Practical significance of this work is as follows: the archive data, which are for the first time used for scientific investigation and also the conclusions formulated in this article can be used for further scientific research of the USSR military industry in the industrialization period and on military production lend-lease during the Great Patriotic War and also in Soviet history in general.

The aim of the article. Establishment and development of the USSR rocket weapons for the period of the New Economic Policy and industrialization is one of the most interesting and poorly researched problem of the USSR military industry. The USSR first researches in the field of rocket weapons and ammunition creation, their features and results are poorly investigated by national historical science and just they are observed in the paper. Methodology. General principles of historism and objectivity are the theoretical-methodological base of this work. Author also use special historical methods: logic, systematic, chronological, actualisation and periodizing. Results. The paper is written by using the declassified documents for Official Use Only, by military technical documents, stored in the Russian National Library, little known memories of direct participants and some published researches. By considering these documents and materials it become clear that in the USSR before the Great Patriotic War a complex of problems on rocket weapon implementation were conditioned by objective and subjective reasons. The consequence of this was the adoption of some unfounded species of reactive weapons before the Great Patriotic War, who received an overestimated assessment and not justified all expectations and hopes assigned to them during the fighting. As a result, only by the end of the war these systems began to be used for their true purpose. Practical application. Practical significance of this work is as follows: facts shown in the article and conclusions drawn on them can be used for further research of USSR rocket weapon establishment and development in 20-40th years of XX century and also for Soviet history in general.

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.