Academic literature on the topic 'Australian Army history'

This article examines the most militarily important indigenous units formed by Australia, arguing that racially based assumptions played a central role in how Papua New Guinean soldiers were conceptualized and used by the Australian Army during the 1940s and 1950s. Equally, while the perception of Papua New Guinean soldiers was heavily racialized, there was no construction of a martial race myth by Australians, in contrast to many colonial armies. Instead, Australia reluctantly recruited Papua New Guineans as a form of cheap manpower familiar with local conditions and saw them as simple soldiers who were potentially a threat to colonial rule.

Between 1941 and 1945, as the U.S. military machine sent millions of Americans——and American culture——around the world, several thousand African Americans spent time in Australia. Armed with little knowledge of Australian racial values and practices, black Americans encoutered a nation whose long-standing commitment to the principle of "White Australia" appeared to rest comfortably with the segregative policies commonly associated with the American South. Nonetheless, while African Americans did encounter racism and discrimination——practices often encouraged by the white Americans who were also stationed in Australia during the war——there is compelling evidence that their experiences were not always negative. Indeed, for many black Americans, Australians' apparent open-mindedness and racial views of white Britons and others with whom African Americans came into contact during the war. Making use of U.S. Army censors' reports and paying attention to black Americans' views of their experiences in Australia, this article not only casts light on an aspect of American-Australian relations that has hitherto recieved scant scholarly attention and reveals something about the African American experience, but also offers insights into race relations within the U.S. armed forces.

The history of the Australian and new Zealand corps (ANZAC) in preparation for the landing on the Gallipoli Peninsula in the Egyptian training camps is studied. The relationship between the rank and file of the corps is analyzed. The study examines the living conditions and relationships of Australians and new Zealanders with the local population in and around Cairo. The study examines the training of corps units in training and exercises, the attitude of soldiers and officers to the quality of training of corps troops, as well as the participation of troops of the Australian-new Zealand army corps in the repulse of the Turkish offensive on the Suez canal in February 1915. An overview of the actions of the landing command to concentrate ANZAC forces in Mudros Bay (Lemnos) before the start of the landing at Gallipoli is given. The article makes extensive use of archival materials of the Australian War Memorial and British archives, the official history of Australia’s participation in world war I, diary entries and letters of Australians and new Zealanders who participated in the first convoy from Australia to Alexandria (Egypt), Russian and foreign research on the initial stage of the Gallipoli operation of the allied forces of the Entente against the Ottoman Empire..

While the Australian Imperial Force of 1914–1918 experienced a significant shift from amateurism to professionalism over the course of the war in most areas, one crucial role not yet examined in the literature on the Australian Imperial Force is that of army cook. This article argues that their role was not taken sufficiently seriously during the Great War, leaving them effectively still amateurs at the end of the war. It explores the regulations for army cooks, the processes of selection, training and monitoring, as well as their performance in camps and in the field, and draws the conclusion that the army failed to professionalize role.

Archibald McLean qualified in Sydney in 1910 and in the following year joined Douglas Mawson’s Australasian Antarctic Expedition (1911–1914). He took a full part in the expedition and was forced to stay an extra year when Mawson failed to return to the base before the ship left. During this time he edited the expedition newspaper, The Adelie Blizzard. His writing impressed Mawson who invited him to work on the book about the expedition. This necessitated visiting England to liaise with publishers and promote the book. He was in England when the First World War broke out and he was commissioned in the RAMC and sent to France. He was invalided out of the army in 1916 and returned to Australia where he obtained his MD for his research in the Antarctic. Then he joined the Australian Army Medical Corps and returned to France where he won the Military Cross and he also suffered gassing. During the war, he developed TB and was unwell when he returned to Australia.

This thesis examines the logistical support of the Australian Army???s operations in the South West Pacific from January 1943 to August 1945. It begins by examining the strategic context. Succeeding chapters then examine various topics, including doctrine, base development, problems of storage and tropic proofing, inland water transport, road construction, air supply, amphibious operations and the support of combat operations. In this thesis I argue that the Australian Army???s logistical acumen and ability steadily grew with each campaign, resulting in a highly effective military organisation that inflicted a series of crushing defeats on the Japanese.

In 1976, the publication of A History of Australian Defence and Foreign Policy, 1901-1923: Volume 1 — The Search for Security in the Pacific, 1901—1914 by Dr Meaney focussed attention on the advice given by professional naval and military staffs to Australian Prime Ministers and defence ministers in the formulation of an Australian defence and foreign policy from 1901 to 1914.

The aim of this thesis is to provide a general history of the army cadet movement in Australia from 1866 to 2004 by tracing the interactions between four fundamental forces that have stood as its foundation for almost 140 years. In various guises military, educational, social, and financial factors are the pillars on which the cadet movement has always rested. Over time the balance and relative dominance of each has determined the shape and state of the cadet organisation and will continue to do so in the future. When these four forces have been aligned the movement has thrived but when they have pulled in disparate directions it has faltered. Throughout the thesis, contextualising these four key concepts, are two more general themes concerning the influence of conservative politics and a recurring state school/private school divide. The history of army cadets, and therefore this thesis, is an investigation into the interplay of these dynamics. With such a purpose and methodology the thesis begins by tracing the development of the movement from its nineteenth century origins by identifying issues and circumstances that led some colonies to maintain thousands of cadets while others struggled to field any. It goes on to examine the formation, five years after Federation, of a Commonwealth cadet scheme birthed only to be swamped by the era of compulsory military training in Australia from 1911-29 which saw, at its peak, almost 100,000 schoolboys in khaki. The thesis analyses the re-organised voluntary cadet system in place from 1930-38 which, matching the circumstances of the adult army, faltered in numbers and support as it was restructured into dual 'Regimental' and 'School' branches. It goes on to assess the impact of the Second World War and the renewed impetus it provided to the cadet organisation before investigating the prosperity of the movement throughout the 1950s and 1960s in spite of the complexities raised by National Service and Australian involvement in conflicts in Korea, Vietnam, Malaya and Borneo. Particular attention is paid to the early 1970s and the machinations surrounding the unexpected decision to disband the cadet organisation announced by the Labor government on 26 August 1975. The cadet story does not conclude at this point, however, with Vice Regal controversy and a subsequent Liberal-National election victory resurrecting the movement. The re-styled cadet scheme of 1976-83 is investigated followed by twelve years of division and distress under consecutive Labor federal governments between 1984-95. The thesis concludes by examining the reversal of fortunes for the movement from 1996-2004 which saw the cadet system develop, by the end of the period, into a well led, resourced and motivated organisation of almost 17,000 members. The research informing this thesis is based on documents held in National Archives of Australia offices in all state capitals, as well as those held in the Australian War Memorial. In addition, all state public record offices have yielded significant material, as have a wide range of private and school-based archives. More recent primary source information has been gathered from sources within the Department of Defence Archives, Queanbeyan, NSW, while select active and closed files from Headquarters Australian Army Cadets and the Directorate of Defence Force Cadets were graciously provided to the author. The study has also been informed by a wide selection of official, privately published and unpublished secondary sources spanning more than a century.

This thesis examines the Citizen Military Forces (CMF) from 1947 until it ceased to exist under that name with the release of the report of the Millar Inquiry in 1974. This thesis examines three broad areas: the organizational changes that the CMF adopted or had imposed upon it; the political decision-making surrounding the CMF; and a social analysis of the CMF which questions the viability and validity of a number of the CMF???s long held precepts. The thesis will show that the majority of circumstances and decisions surrounding the CMF were beyond its control. For example, the CMF could not change the prevailing military thought of the post-war period which emphasized increasingly the role of smaller, professional, readily-available armies. The first three chapters recount the CMF???s ???heyday??? in which the Army, assisted by National Service after 1950, was based around it and its influence at the highest levels was strongest. The next two chapters chronicle the background to Australia???s adoption of the ???Pentropic??? organization and the repercussions this had on the CMF. Chapters Six and Seven examine the consequences of the introduction of a second compulsory service scheme and the concomitant result which precluded the CMF from operational service in Vietnam. Chapters Eight and Nine deal with the Millar Inquiry, which offered the CMF a new hope, but in some regards, brought forth little beneficial gains for the CMF. The final chapters analyze some of the characteristics unique to the CMF, such as territorial affiliation, high turnover rates amongst the rank and file and the concept of the ???brilliant amateur???. This thesis concludes that, despite the mixed performance of the CMF, there is still a place for the citizen soldier in contemporary warfare, but far more consideration at the highest political and military levels must be given to the peculiar and difficult, but by no means insurmountable, problems citizen soldiering encounters in Australia.

Constructions of memory, myth and legend relating to Gallipoli have dominated the academic assumption which suggests that this dimension alone has allowed for the reawakening of the exceptional interest in the Anzac tradition; a tradition that has converged at the physical site in modern day Turkey. While these intangible constructions have waxed, waned, and re-emerged over the Twentieth Century, possessing the site to commence the construction of an Anzac Battlefield Cemetery has been ignored in academic enquiry. This significant series of events from 1916 to 1965 were indispensable to memory perpetuation and essential to the commemorative primacy that this preserved headland now enjoys. The desire to repossess, and then own in perpetuity the battlefield in order to attach the appropriate masonry adornments, is in itself unique. This dimension has not been academically scrutinised by any historian until now. Nor has the deliberate desire to construct an Anzac shrine that would someday attract pilgrims from the Antipodes been studied. Present day site-sacralisation by rite-of-passage pilgrims, thoroughly emersed in the Anzac tradition, suggests the convergence of the two dimensions is complete. To counteract this problem of the �hegemony of the intangibles� this thesis explores primary sources, gleaned largely from archival records, then evaluates the significance of the history of �physical Gallipoli.� Thematic approaches based upon the lines of possession, preservation and pilgrimage argue that this parallel dimension has played an indispensable role in shaping the end result today. Tens of thousands Australasian travellers now flock to this preserved battlefield to encounter the actual physicality of the tradition. The battlefield cemetery, complete with botanical emblems of ownership, had been out of the reach of the very generation who had created, acquired and constructed the battlefield landscape. The New Zealand public had to be content with assorted forms of vicarious pilgrimage coupled with widespread domestic memorialisation. New Zealand�s post-evacuation experience at Gallipoli became a story completely distinctive from that of Australia or Great Britain. The deliberately constructed Anzac Battlefield Cemetery is a unique landscape artefact that a proud but mournful generation set out to create. They eventually achieved this end by a complicated mixture of conquest, occupation, careful preservation, and commemorative ownership. These efforts were assisted by the vagaries of economic happenstance and international politics that left this remote Peninsula isolated and off-limits to human encounter. Fortuitously frozen in time, this landscape artefact, so steeped in Classical history, has emerged as one of the most sacred, and perhaps the most recognisable, geographic features associated with Australasia. Overriding these plans for shrine construction had been the stated goal of securing a reverent final resting place for those who fell during the creation of the Anzac legend in 1915. Sepulture perpetuelle became the post-evacuation catchphrase that propelled this Great War generation to go almost to the brink of war to secure the principles of this phrase. This lofty goal of permanence, by passage of time and the re-appropriation of nature, had mercifully been completed before the current �second invasion� that commenced in the 1980s. The Anzac Battlefield Cemetery is now a victim of its own very successful physical preservation.

Despite the place that the Light Horse occupies in Australia???s military history and the national martial mythology, there has not yet been a scholarly attempt to investigate the evolution and development of Australia???s mounted branch. This thesis is the first attempt to fill this gap in our knowledge and understanding of the history of the Australian Army. In doing so it will consider the ways in which the Light Horse evolved, the place it had in defence thinking, the development of its doctrine, its organisational changes and the way in which that organisation and its men interacted with their society. This thesis firstly analyses the role and place of the mounted soldier in the British and colonial/dominion armies in the late nineteenth and early twentieth centuries before going on to examine what effects the debates about this had on the development of Australia???s mounted troops. It will find that in the nineteenth century the disparate mounted units of the Australian colonies were established mainly along the organisational model of the mounted rifleman. Influenced by social ideas about citizen soldier horsemen and a senior officer with firm views, this model continued to be used by the new Light Horse until well into the First World War. During that war it was gradually discovered that this military model had its limitations and by the end of the war much of the Light Horse had become cavalry. This discovery in turn meant that during the inter-war period cavalry continued to be part of the army. Analysed in depth also are the many organisational changes that affected the mounted branch during its existence. Some of these reflected doctrinal and tactical lessons, and others were the result of various plans by the government and military authorities to improve the army. It will be seen that regardless of these plans part-time citizen horse units continued to have many problems and they rarely came to be what the government wanted of them. That they were as strong as they were was testimony to the efforts of a dedicated and enthusiastic few.

Imperial Japanese soldiers were notorious for following their superiors to certain death. Their enemies in the Pacific War perceived their obedience as blind, and derided them as “cattle”. Yet the Japanese Army was arguably one of the most disobedient armies in the world. Officers repeatedly staged coups d’états, violent insurrections and political assassinations, while their associates defied orders given by both the government and high command, launched independent military operations against other countries, and in two notorious cases conspired to assassinate foreign leaders. The purpose of this dissertation is to explain the culture of disobedience in the Japanese armed forces. It was a culture created by a series of seemingly innocent decisions, each reasonable in its own right, which led to a gradual weakening of the Japanese government’s control over its army and navy. The consequences were dire, as the armed forces dragged the government into more and more of China in the 1930s, and finally into the Pacific War. This dissertation sheds light on the underground culture of disobedience that became increasingly dominant in the Japanese armed forces, until it made the Pacific War possible. Using primary sources in five languages, it follows the Army’s culture of disobedience from its inception. By analyzing more than ten important incidents from 1860 to 1931, it shows how some basic “bugs” programmed into the Japanese system in the 1870s, born out of genuine attempts to cope with a chaotic and shifting reality, contributed to the development of military disobedience. The culture of disobedience became increasingly entrenched, making it difficult for the Japanese civilian and military leadership to cope with disobedient officers without paying a significant political price. However, every time the government failed to address the problem, it became more acute. Finally, disobedient military officers were able to significantly influence foreign policy, pushing Japan further towards international aggression, limitless expansion, and conflict with China, Britain and the United States.
History

Né dans les tranchées de la Première Guerre Mondiale, Anzac est le plus grand mythe de l’Australie blanche. La participation des troupes de l'Anzac (Australian and New Zealand Army Corps) au conflit a marqué la véritable naissance de la nation et a laissé une empreinte indélébile dans la conscience australienne. La fascination exercée par ANZAC sur l'imagination nationale a été particulièrement évidente dans les années quatre-vingt, durant lesquelles plusieurs films de cinéma et de télévision ayant la Grande Guerre pour sujet ont été produits. Ces représentations obéissent à une volonté commune de réillustrer le mythe dans sa forme traditionnelle et de résister à la démythification, révélant l'état d'esprit de l’Australie durant cette période
Born in the trenches of World War I, Anzac is white Australia’s greatest myth. The involvement of troops from the Anzac (Australian and New Zealand army corps) in the conflict is considered as the turning point in the nation's history and has made a lasting impression on the Australian consciousness. The fascination which Anzac exerts on the national imagination was particularly obvious in the 1980's, when the great war was the subject of a few films and television series. These portrayals show a common will to reillustrate the myth in its traditional form and to resist demythification, thus revealing Australia’s state of mind during this period

About 3850 men of the First Australian Imperial Force were captured on the Western Front in France and Belgium between April 1916 and November 1918. They were mentioned only briefly in the volumes of the Official Histories, and have been overlooked in many subsequent works on Australia and the First World War. Material in the Australian War Memorial has been used to address aspects of the experiences of these neglected men, in particular the Statements that some of them completed after their release This thesis will investigate how their experiences ran counter to the narratives of CEW Bean and others, and seeks to give them their place in Australia???s Twentieth Century experience of war.

This chapter talks about “enemy alien” internees that arrived in Australia in 1940, who would be enlisted as soldiers in an Australian Army labor corps and work as noncombatants to do their part in the war against the Axis powers. It considers the story of the enemy aliens from Germany and Austria as one of the most remarkable episodes in the immigration history of twentieth-century Australia. It also highlights the account of the enemy aliens in relation to the manpower management in a country that was manpower poor. The chapter recounts the so-called Phoney War that ended on 10 May with the German invasion of the Low Countries and France, while Britain stood alone awaiting a German invasion. It refers to Sir John Anderson, who declared that the British government would draw a clear distinction between enemy aliens and refugees from Germany and Austria.

Donkeys carried Christ into Jerusalem, transported the Greek god Dionysus to his childhood home on Mount Nysa and into battle against the Giants, and provided a mount for Muhammad, who supposedly used it to summon his companions. Long before the arrival of the horse, they were ridden by kings in the Near East, buried near Egypt’s first pharaohs, and sacrificed to ancient gods across the Fertile Crescent and as far beyond it as Baluchistan and Badajoz. Along with their hybrid offspring, the mule, donkeys formed—and in places still form—a core technology for moving goods at both local and international levels, especially in areas of rugged or mountainous terrain: agricultural produce throughout the Mediterranean Basin, the Middle East, and beyond; tin and wool for Bronze Age merchants between Assyria and Anatolia; supplies for the Roman army; New World silver to Caribbean ports for shipment to Spain; salt in contemporary and medieval Ethiopia; household necessities and even the dead in the modern Moroccan city of Fez. Their muscles ground flour in the Classical Mediterranean, powered water wheels in Islamic Andalucía, and helped deliver stone columns from Egypt’s deserts to build the Pantheon in Rome. Today, they remain a critical resource for many of the world’s poor, their use promoted by numerous development projects. At the same time, conservation authorities in places as distant from each other as Australia and the United States seek to control the numbers of feral donkeys using means that pose impossible-to-resolve ethical questions. And yet, for most twenty-first-century individuals in the Western world, donkeys are among the least considered of the animals that people have domesticated. Tellingly, for example, a recent overview of the archaeology of animals completely omits them, while nevertheless including the Muscovy duck (Cairina moschata), a tree-nesting bird kept by Pre-Columbian Native Americans, in its table of ‘major domestic animals’. Rarely seen and even more rarely eaten, donkeys are perhaps met with on foreign holidays or encountered as unusual companion animals, participants in school Christmas celebrations, or seaside attractions for small children.

So far, the geographical foci of our regional–thematic examination of the linkages between war and disease have been the great continental land masses of the Americas, Europe, Asia, and Africa. We now turn our attention to a different stage for the geographical spread of war epidemics—oceanic islands. As well as the particular interest which attaches to islands as natural laboratories for the study of epidemiological processes (Cliff et al., 1981, 2000), island epidemics also hold a special place in war history. For example, we saw in Chapter 2 how the islands of the Caribbean became staging posts for the spread of wave upon wave of Old World ‘eruptive fevers’ (especially measles, plague, smallpox, and typhus) brought by the Spanish conquistadores to the Americas during the sixteenth century. Much later, the mysterious fever that broke out on the island of Walcheren in 1809 ranks as one of the greatest medical disasters to have befallen the British Army. In this chapter, we examine the theme of island epidemics with special reference to the military engagements of Australia, New Zealand, and the neighbouring islands of the South Pacific since 1850. Figure 11.1 serves as a location map for the discussion, while sample conflicts—exclusive of tribal feuds, skirmishes, and other minor events for which little or no documentary evidence exists—are listed in Table 11.1. Our analysis begins in Section 11.2. There we provide a brief review of the initial introduction and spread of some of the Old World diseases which occurred in association with South Pacific colonization and conflicts during the last half of the nineteenth century. In Sections 11.3 and 11.4, we move on to the twentieth century. In the Great War, Australia and New Zealand made a relatively larger contribution to military manpower than any other allied country. At the end of the conflict, the return of many tens of thousands of antipodean troops from the battlefields of Europe fuelled the extension of the 1918–19 ‘Spanish’ influenza pandemic into the South Pacific region (Cumpston, 1919). In Section 11.3, we examine the spread of influenza on board returning troopships and subsequently within Australia, New Zealand, and the neighbouring islands of the region.

Abstract This paper presents the development of a three-dimensional (3D) geotechnical model for an existing water dam in Queensland, Australia. The model incorporated data from historic construction records, recent investigation data as well as previously developed two-dimensional cross section interpretations and geological mapping records. The 3D model provided the project team and other stakeholders the ability to interrogate the ground model to an unprecedented level of detail. The geotechnical model development was complimented by an in-depth rock mechanics assessment to investigate kinematically feasible sliding mechanisms beneath the dam spillway and abutments. This package of work included creation of a discrete fracture network model. The DFN modelling in this study was undertaken in two stages, with an initial model built to be representative of sub-horizontal fractures (with a dip of <15°), followed by a refined model, built to be representative of all fractures at the site. The paper presents the input parameters, derivation of these parameters along with the model generation process are presented for both stages. The modelling was undertaken for both rock mass visualization and sliced on two cross-sections for input into 2D Finite Element analyses. This was particularly targeted at understanding intact rock forming bridges between laterally persistent defects within the volcanic host rock that were previously identified as a key risk to dam stability in the event of an overtopping event.

ABSTRACT: With the continuous depth breakthrough of two ultra-deep exploration wells in northeastern Sichuan block, tuff reservoir was finally discovered at the depth of 6700-7300 m. It belongs to ultra-deep tight gas reservoir with low brittle mineral content and high clay content. Hydraulic fracturing is hard to be reformed this special reservoir, easy to appear hydration expansion and other problems. However, the research and development of such tight tuff reservoir with high temperature and high pressure are relatively low in the domestic and overseas until now. Therefore, it is of great significance to carry out experimental research on relevant reservoir reconstruction methods of such rocks and explore the factors of fracture conductivity here. In this study, the influence of acid type, sanding concentrations, proppant size was research by a new experimental installation. The factors of fracture conductivity are analyzed by experimental data and the reconstitution of fracture surface. The results show that before the abnormal point, the acid etching effect of crosslinked acid on tuff is better than that of gelling acid. At the condition of closure pressure is lower 30 MPa, the higher sanding concentrations, the higher fracture conductivity, then narrowed the gap among them. Meanwhile, the larger proppant size, the higher fracture conductivity in low closure pressure. With increasing closure pressure, fracture conductivity of smaller size proppant decreased slowly. In conclusion, it is also convenient for the field operation to choose the best acid and proppant parameters. 1. INTRODUCTION As an important new field of exploration and development of oil and gas resources in the world, igneous reservoir have gradually received extensive attention from geological and petroleum researchers all over the world. The exploration and research on the igneous reservoir has a history of more than 130 years. Now, some igneous reservoir have been exploited in the United States, Indonesia, Japan, Brazil, Australia and other countries (Tang, et al. 2020). Its oil and gas mainly come from athrogenic rock reservoir. Athrogenic rock is a transitional type between magmatic rocks and sedimentary rocks, and it is also one of the important reservoir rock types. It has the advantages of thick pay information and large reserves (Li, et al. 2015). The tuff reservoir is very complex and special and has both lithologic characteristics in terms of petrophysics and diagenesis (ZHANG, et al. 2012). The low degree of development of original porosity and poor connectivity of pore throats indicate that such reservoir is tight reservoir (Zeng, et al. 2021). At present, the well known athrogenic rock reservoir in the world including East Anatolia Basin in Turkey (Gecer-Buyukutku, et al. 2005), Bohai Bay in China (Zhao, et al. 1996), Erlian (Guo, et al. 2013) and Hailar (Yu, et al. 2013) basins.

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.