Academic literature on the topic 'Breast Examination South Australia'

Marine communities are frequently biogeographically structured, despite the potential for dispersal. Previous research on a variety of marine taxa in south-eastern Australia has suggested that a biogeographic break occurs along the coastline of Victoria. However, little of this research has focussed on nearshore ichthyofauna and the location of the break remains debated. Using fish abundance measured by two methods: underwater visual census (UVC); and baited remote underwater video (BRUV) at six locations along the open coast of Victoria, we examined (1) whether there is sufficient concordance among species to indicate the presence of a faunal break; and if present (2) where any such breaks occur. Differences in assemblage composition between locations were tested with analyses of similarity and examination of residuals from regressions of pairwise dissimilarities against coastline distance. Data collected using UVC revealed two large faunal breaks co-located with a habitat discontinuity, the convergence of two currents and a thermal gradient. Data collected by BRUV revealed only a gradation of change across the study region. Greater understanding of the biogeographic structure of these communities will facilitate more effective management, especially in light of anticipated range shifts in response to global climate change.

People with intellectual disability experience inadequate health care and have unmet health needs that can go unidentified or be poorly managed. Health assessments have been shown to significantly increase short-term clinical activity for people with intellectual disability. The aim of this study was to more accurately quantify the effect of health assessments for people with intellectual disability by comparing health actions recorded in health assessment booklets to actions recorded in general practitioners’ (GPs) records in the 12-month period following the health assessment. Participants were people with intellectual disability who had received a Comprehensive Health Assessment Program (CHAP), living in the community. The CHAP is a health assessment that is demonstrated to significantly increase health actions, compared with usual care, for people with intellectual disability. Data collected from three randomised controlled trials conducted in South-East Queensland, Australia, from 2000 to 2010 were pooled and analysed. The health assessment booklet contained significantly more information on health actions than GPs’ records. Notably, hearing tests (risk ratio (RR) = 5.9; 95% confidence interval (CI) = 4.7–7.4), breast checks (RR = 3.9; 95% CI = 2.7–5.7), and skin examinations (RR = 7.9; 95% CI = 5.9–10.7) were more likely to be recorded in the CHAP booklet. Health assessments increase health actions for people with intellectual disability to a significantly greater extent than previously demonstrated.

Background and context: Thiruvananthapuram has the highest breast cancer incidence in India and majority of cases are detected late pointing to the inefficiency of early detection programs. Primary health care providers do not advise regarding regular screening and most women never resort to any screening practices. Mammogram is not cost-effective and clinical breast examination (CBE) is not popular as a screening modality in our population. Aim: To describe the conduct, utilization and outcome of mass screening program conducted in Thiruvananthapuram. Strategy: A mass screening program with media publicity to motivate organizations and residential associations was planned. CBE was conducted by one of the five lady doctors who were trained by an expert breast surgeon at a tertiary care center to detect suspicious lumps. All suspicious cases referred to experts who would further evaluate the cases at a clinic outside the tertiary care center. Advocacy and expert service at accessible sites and availability of expert service outside the tertiary care center at convenient timings improved the acceptance of screening. Intersectoral coordination, community participation, accessible expert services and appropriate technology were followed. Program/Policy process: 9942 women had CBE along with breast awareness in 101 camps over 66 days and it was probably “the first ever marathon breast cancer screening campaign” in the world. Sociodemographic variables, details regarding previous screening, breast symptoms and known risk factors were collected. Anyone with suspicious findings was referred to experts. Outcomes: 868 (8.73%) women with suspicious findings were referred to experts who advised 258 mammograms and confirmed breast cancer in 16 women (1.61 per 1000 women). Mean age was 45.46 years. 82.5% had screening for the first time. Uniformity in examination, three levels of screening and minimum utilization of diagnostic procedures makes this campaign distinct from others. All participants are kept on follow-up through a free clinic maintained by a nonprofit NGO in Thiruvananthapuram. Effective planning and selfless service along with coordinated effort of an apex institution (Regional Cancer Centre, Thiruvananthapuram), a private medical college (Sree Gokulam Medical College, Thiruvananthapuram) and media partners were the key to success. What was learned: Early detection of breast cancer is possible by CBE, provided women can be motivated for regular screening and adequate expertise is available. CBE campaigns can improve screening behavior and breast awareness among women. Primary health care providers and mass media could educate women regarding the benefits of breast awareness and motivate them for regular screening. Proper referral system including certified intermediate referral centers should be in place to ensure the success of early detection by CBE.

Close examination of Orthoprotella mayeri K.H. Barnard, 1916 (sensu lato) which has been recorded from South Africa and New South Wales, Australia, revealed that there are two distinct species from Cape Province, South Africa and New South Wales, Australia, respectively. The present paper provides a redescription of O. mayeri K.H. Barnard, 1916 (sensu stricto) from South Africa and a description of O. berentsae sp. nov. from New South Wales, Australia. The two species can be identified based on the morphology of antenna 2, pereonites 6 and 7, and the uropods, although characteristic body somites of both species resemble other species.

Philosophiae Doctor - PhD
Cancer is a major public health concern in both developed and developing countries; it accounts for 13% of all deaths globally, of which 70% occur in middle- and low-income countries. In Nigeria, over 10 000 cancer deaths and 250 000 new cases of cancer are recorded yearly. Breast cancer is the second most common cancer worldwide, after lung cancer. It is the most common type of cancer diagnosed in women and the most common cause of death worldwide. Late detection and diagnosis of breast cancer leads to high mortality rate. In Nigeria certain cultural taboos are associated with breast cancer, which lead to poor information dissemination to women in rural communities. Breast self-examination (BSE) provides an inexpensive method for early detection of breast tumours. Knowledge and awareness about Breast Self-Examination are critical to promote consistent practices when the people concerned are empowered with the needed information to acquire the knowledge and skills which will inform practice of any health issue. In Nigeria it was reported that the number of women at risk of breast cancer increased progressively from 24.5 million in 1990 to about 40 million in 2010. This number is projected to rise to over 50 million by 2020, should the trend continue unabated. The current study explored the understandings of breast cancer and prevention, with particular emphasis on BSE practice among rural women, and developed an empowerment programme to promote uptake of this practice in a rural community in a south-western state of Nigeria. The study was framed in the Health Belief Model and Kieffer’s empowerment process. Participatory action research was used as study design and approach; and utilized both qualitative and qualitative methods. The sample for quantitative phase comprised 345 women aged 20 to 60 years, selected from 5 communities using a cross-sectional procedure. Data gathering instrument was a questionnaire. Summative statistics were calculated using the SPSS program. The sample for qualitative phase comprised of 95 women who were selected from the respondents to the quantitative phase. The data was collected through focus group discussion. The qualitative data was subjected to thematic analysis. Three themes that emerged for qualitative analysis which are: knowledge/awareness of BSE, practice and appeal for intervention, and misconception and fear. The survey results showed that a large proportion of the respondents (75.1% and 76.5%) had low levels of knowledge about BSE and did not practice BSE. Also, about 77% of the respondents expressed one form of barrier or another to BSE practice. However, despite these inadequacies, 87% of the respondents were ready and willing to improve their health if empowered with the right information and motivation. The empowerment program informed by the quantitative and qualitative phases and the stages of change with the full participation of the women. The program consisted of hands-on physical demonstrations, BSE pamphlets, and mnemonic songs were identified media of disseminating knowledge and practice of BSE. These media became the platforms for the empowerment programme developed for the women. A day was also set aside, just as is done for immunisation, for BSE practice and other women’s health issues to promote the prevention of breast cancer in the community. The “Physical demonstration” intervention resulted in an increase in the correct BSE practice from 23.5% at the beginning of the study, to 85.3% post the intervention. The “other intervention” resulted in 80% to 94.7% of participating women being able to practice correct physical step-by-step performance of BSE. The participatory approach contribute to a high levels of participation by women in Iddo local Government which led to the increase in the correct Breast Self–Examination as stated above.

Australian Palms offers an updated and thorough systematic and taxonomic treatment of the Australian palm flora, covering 60 species in 21 genera. Of these, 54 species occur in continental Australia and six species on the off-shore territories of Lord Howe Island, Norfolk Island and Christmas Island. Incorporating recent advances in biogeographic and phylogenetic research, Australian Palms provides a comprehensive introduction to the palm family Arecaceae, with reviews of botanical history, biogeography, phylogeny, ecology and conservation. Thorough descriptions of genera and species include notes on ecology and typification, and keys and distribution maps assist with field recognition. Colour photographs of habit, leaf, flowers, fruit and unique diagnostic characters also feature for each species. This work is the culmination of over 20 years of research into Australian palms, including extensive field-work and examination of herbarium specimens in Australia, South-East Asia, Europe and the USA.

The south-east Queensland region is currently experiencing the most rapid urbanisation in Australia. This growth in human population, industry and infrastructure puts pressure on the unique and diverse natural environment of Moreton Bay. Much loved by locals and holiday-goers, Moreton Bay is also an important biogeographic region because its coral reefs, seagrass beds, mangroves and saltmarshes provide a suitable environment for both tropical and temperate species. The bay supports a large number of species of global conservation significance, including marine turtles, dugongs, dolphins, whales and migratory shorebirds, which use the area for feeding or breeding. Environmental History and Ecology of Moreton Bay provides an interdisciplinary examination of Moreton Bay, increasing understanding of existing and emerging pressures on the region and how these may be mitigated and managed. With chapters on the bay's human uses by Aboriginal peoples and later European settlers, its geology, water quality, marine habitats and animal communities, and commercial and recreational fisheries, this book will be of value to students in the marine sciences, environmental consultants, policy-makers and recreational fishers.

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.

This chapter, by Ian Phimister, examines the global financial dynamics of the southern African and “Westralian” gold-mining share manias of the 1890s. Examination of both mining share markets suggests that, contrary to the conventional portrait painted of gold rushes, the defining picture is less one of prospectors rushing to pan for gold or peg claims than it is one of company promoters scurrying to fleece investors. The most frenzied activity was on the floor of the London Stock Exchange, not on the South African Highveld or the dry, dusty plains of Western Australia. More minted gold was found in London and the Home Counties than mined gold was located in Southern Africa or Western Australia. It is an exercise that once again questions the efficiency of late Victorian capital markets, even as it points to the consequences of the “portal of globalization” opened by finance.

In Chapters 4–8, we have examined a series of processes that, often working in combination, have served to precipitate the emergence and re-emergence of infectious and parasitic disease agents in the human population. In this chapter, we conclude our survey with an analysis of temporal trends in disease emergence and re-emergence since 1850. The discussion is informed by long-term shifts in the underlying causes of mortality encapsulated in Omran’s model of epidemiological transition (Section 1.4.1), paying particular attention to the manner in which sample infectious and parasitic diseases have waxed and waned at a variety of geographical scales from the global to the local over the last ∼150 years. Our choice of examples strikes a balance between coverage of geographical regions and epidemiological environments, and coverage of important diseases that we have not so far examined in detail. Our consideration is structured by geographical scale: (1) At the global level, we discuss three major human diseases that have undergone phases of rapid global expansion since 1850—plague, cholera, and HIV/AIDS (Section 9.2). (2) At the regional level, we examine twentieth-century trends in general infectious disease mortality in the advanced economies of Europe, North America, and the South Pacific, 1901–75, before looking at time sequences for sample emerging (Ebola–Marburg) and cyclically re-emerging (meningococcal) diseases in sub-Saharan Africa (Section 9.3). (3) At the national level, we use Hall’s (1993) data to establish the main trends in morbidity due to infectious diseases in Australia, 1917–91 (Section 9.4). (4) At the local level, we extend our examination of long-term disease trends in London, described for the pre-1850 period in Section 2.4, into the late twentieth century (Section 9.5). The chapter is concluded in Section 9.6. In this section, we examine long-term trends in three major human infectious diseases that have undergone phases of global expansion in the last 150 years: plague (Section 9.2.1); cholera (Section 9.2.2); and HIV/AIDS (Section 9.2.3).

Objective: The aim of this study was to analyze a prevalence relationship between the results of breast cytopathological examinations and the regions of Brazil. Methodology: This is a retrospective, epidemiological, and cross-sectional study, where the data were obtained from the Breast Cancer Information System, regarding the results of breast cytopathological examinations performed by fine-needle aspiration (FNA), from January 2009 to July 2015. The Brazilian North, Northeast, Southeast, South, and Midwest regions were selected. The FNA result variables selected were as follows: benign negative malignancy processes, compatible undetermined malignancy, suspect for malignancy, positive for malignancy, and inconsistent information. The collected data were tabulated and treated statistically to determine the absolute prevalence, analyzing the percentage relationship between the results of the FNA and social conditions of the regions. Results: In total, 63,240 cytopathologies were reported by FNA in Brazil, the region with the highest prevalence of this examination was the Southeast, with 39% (n=24,618), followed by the Northeast, with 30.3% (n=19,162), being the North, the lowest prevalence of notifications, 2.6% (n=1,665). Among the results of the FNA, the highest frequency of the examinations resulted in a benign result, representing 88% of the total (n=55,685). The highest incidence of biopsies positive for malignancy was in the Southeast, 8.3% (n=2,056). Conclusion: The Southeast has greater socioeconomic development, which contributes to an increase in risk factors for women in the region, such as a lower number of pregnancies, as well as postponing it. The results found leave room for further investigation, given that populous regions, such as the North, and with significant population aging, such as the Midwest and the South of Brazil, reported a very small number of biopsies performed, which may reflect failures in public health policy, difficulty in accessing the test or underreporting of this procedure.

RESUMO A abordagem sistêmica é um processo interdisciplinar, cujo princípio primordial é compreender a interdependência recíproca e relações de todas as áreas e da necessidade de sua integração, permitindo maior aproximação entre os seus limites de estudo. Nesse contexto o olhar sistêmico, da ergonomia, sobretudo no que se refere à segurança, ao conforto e à eficácia de uso, de funcionalidade e de operacionalidade dos objetos, considerando todos os produtos ou sistemas de produtos, como sistema de uso, desde os mais simples aos mais complexos ou sistêmicos, tem como objetivo adequá-los aos seres humanos, tendo em vista as atividades e tarefas exercidas por eles. No que se refere ao design funcional, os conhecimentos da ergonomia, nessa visão sistêmica, relativos à sua metodologia de projeto, são absolutamente necessários, e a sua aplicação aponta a melhor adequação dos produtos aos seus usuários. Como é o caso do vestuário feminino funcional, sobretudo no que se refere a proteção das mamas, que são peças convencionais que necessitam de um correto dimensionamento e especificação dos tecidos e de outros materiais. É um tipo de vestuário que apresenta funcionalidade diversa, como para a proteção física, o aumento do volume da mama, enchimento no bojo de pano, de água, de óleo, estruturado com arame, etc.; para amamentação (sutiã que se abre na frente, em parte ou totalmente); para o design inclusivo (pessoas com deficiência e mobilidade reduzida, no caso de mamas com prótese ou órtese) facilitando com fechamentos e aberturas colocadas em peças de roupas difíceis de manusear, roupas confortáveis e fáceis de vestir. São peças usadas por pessoas com biótipos e percentis antropométricos variáveis e com características corporais que mudam significativamente nas passagens para a adolescência, idade adulta e idosa. As mudanças corporais apresentam diferenças significativas em termos de volume das mamas, nas quais as soluções ergonômicas por uma abordagem sistêmicas que se evidencia mais para a complexidade de uso, são as mais necessárias em termos de atributos como, segurança, conforto, comodidade corporal, facilidade do vestir, funcionalidade, além da estética. Esta pesquisa, embora exploratória e descritiva, não isenta de desafios, tem por objetivo, por meio de dados e informações ergonômicas sistêmicas contribuir com o design funcional, de modo a oferecer subsídios para a confecção de roupas funcionais ou tecnologia vestível, com os atributos citados, respeitando a diversidade e inclusão das pessoas em todas as fases de sua vida, atendendo assim os princípios formais do design. Palavra-chave: Abordagem sistêmica, Ergonomia, Design funcional. REFERENCIAS AROS, Kammiri Corinaldesi. Elicitação do processo projetual do Núcleo de Abordagem Sistêmica do Design da Universidade Federal de Santa Catarina. Orientador: Luiz Fernando Gonçalves de Figueiredo – Florianópolis, SC, 2016. BERTALANFFY, Ludwig V. Teoria geral dos sistemas: fundamentos, desenvolvimento e aplicações. 3. ed. Petrópolis, RJ: Vozes, 2008. BEST, Kathryn. Fundamentos de gestão do design. Porto Alegre: Bookman, 2012. 208 p. CHIAVENATO, I. Gestão de pessoas. 3ª ed. Rio de Janeiro: Elsevier, 2010. CORRÊA, Vanderlei Moraes; BOLETTI, Rosane Rosner. Ergonomia: fundamentos e aplicações. Bookman Editora, 2015.MERINO, Eugenio. Fundamentos da ergonomia. 2011. Disponível em: <https://moodle.ufsc.br/pluginfile.php/2034406/mod_resource/content/1/Ergo_Fundamentos.pdf>. Acesso em: 24 Mar 2017. DIAS E. C. Condições de vida, trabalho, saúde e doença dos trabalhadores rurais no Brasil. In: Pinheiro TMM, organizador. Saúde do trabalhador rural –RENAST. Brasília: Ministério da Saúde; 2006.p. 1-27. GIL, A. C. Como elaborar projetos de pesquisa. 4. ed. São Paulo: Atlas, 2010. GOMES FILHO, J. Ergonomia do objeto: sistema técnico de leitura ergonômica. São Paulo: Escrituras Editora, 2003. GUIMARÃES, L. B. M. (ed). Ergonomia de Processo. Porto Alegre, v.2, PPGE/UFRGS, 2000. IIDA, I. Ergonomia: projeto e produção. 2ª ed rev. e ampl. – São Paulo: Edgard Blucher, 2005. MANZINI, Ezio. Design para inovação social e sustentabilidade: comunidades criativas, organizações colaborativas e novas redes projetuais. Rio de Janeiro: E-Papers, 2008, 104p. MARCONI, M. A.; Lakatos, E. M. Fundamentos de metodologia científica. São Paulo: Atlas, 2007. Pandarum, R., Yu, W., and Hunter, L., 2011. 3-D breast anthropometry of plus-sized women in South Africa. Ergonomics, 54(9), 866–875. McGhee, D.E., Steele, J.R., and Munro, B.J., 2008. Sports bra fitness. Wollongong (NSW): Breast Research Australia. McGhee, D.E., Steele, J.R., and Munro, B.J., 2010. Education improves bra knowledge and fit, and level of breast support in adolescent female athletes: a cluster-randomised trial. Journal of Physiotherapy, 56, 19–24. Pechter, E.A., 1998. A new method for determining bra size and predicting postaugmentation breast size. Plastic and Reconstructive Surgery, 102 (4), 1259–1265. RICHARDSON, R. J. Pesquisa social: métodos e técnicas. 3 ed. São Paulo: Atlas, 2008. RIO, R. P. DO; PIRES, L. Ergonomia: fundamentos da prática ergonômica, 3ª Ed., Editora LTr, 2001. SANTOS, N. ET AL. Antropotecnologia: A Ergonomia dos sistemas de Produção. Curitiba: Gênesis, 1997. VASCONCELLOS, Maria José Esteves de. Pensamento sistêmico: O novo paradigma da ciência. 10ª ed. Campinas, SP: Papirus, 2013. WEERDMEESTER, J. D. e B. Ergonomia Prática. São Paulo: Edgard Blucher, 2001. WHITE, J.; SCURR, J. Evaluation of professional bra fitting criteria for bra selection and fitting in the UK. Ergonomics, 1–8. 2012. WHITE, J.;SCURR, J.; SMITH, N. The effect of breast support on kinetics during overground running performance. Ergonomics, Taylor & Francis. 52 (4), 492–498. 2009.

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.