Asbestos Exposure Blind Spot in Lung Cancer Screening Puts Thousands at Risk

Australians who breathed asbestos dust decades ago at work are walking into lung cancer screening programs and walking out unidentified—not because the screening itself is flawed, but because the programs were never designed to look for them. A new study from Curtin University, published in Occupational and Environmental Medicine, has documented a gap in how Australia's lung cancer screening efforts assess risk, one that leaves thousands of people who should be flagged for early detection instead falling through unnoticed.

The problem is structural. Current screening frameworks in Australia focus heavily on smoking history as the primary risk marker for lung cancer. This makes intuitive sense—smoking is the leading cause of the disease—but it creates a blind spot for people whose lung cancer risk comes from a different source entirely: occupational asbestos exposure. Australia has a long industrial history with asbestos. The material was mined, manufactured, and built into construction materials for decades. Workers in mining, construction, and manufacturing handled it routinely. Some of those workers are now in their sixties, seventies, and beyond. They are at genuine, elevated risk for lung cancer. But if their occupational history isn't part of how screening programs assess who needs monitoring, they remain invisible to the system.

Chellan Kumarasamy, the lead researcher on the study and a Ph.D. candidate at Curtin Medical School, framed the issue plainly: asbestos exposure remains a major driver of lung cancer risk in Australia, yet screening criteria do not account for it properly. This is not a minor oversight. It represents a missed opportunity to catch cancer in its earlier stages, when treatment options are broader and survival rates are higher. Late diagnosis of lung cancer in Australia remains a significant problem—it is a leading cause of cancer death in the country, and much of that burden stems from people learning about their disease too late.

The researchers are calling for a rethinking of how risk gets assessed in screening programs. Better occupational history tracking would be one step: asking people directly about their work in industries known to use asbestos, and using that information to identify who should be included in screening. More inclusive screening criteria would be another: expanding the definition of "high risk" beyond smoking status to encompass asbestos exposure as a standalone risk factor, or as a co-factor that elevates risk even in people who never smoked.

Dr. Kim Betts, a senior author from Curtin's School of Population Health, emphasized the public health stakes. If asbestos exposure is not properly accounted for in screening design and implementation, Australia risks leaving behind a group of people who would benefit most from early detection. The national screening program, as it currently stands, is not reaching them. Thousands of at-risk Australians may continue to receive late diagnoses, when the window for effective treatment has already narrowed.

The research does not propose a radical overhaul. It asks for asbestos exposure to be formally recognized and incorporated into how the national screening program identifies candidates for lung cancer monitoring. This is a matter of inclusion—making sure that people whose occupational history put them at risk are not excluded simply because their risk profile does not fit the current template. The cost of not doing so is measured in lives diagnosed too late, in treatment options foreclosed, and in survival rates that could have been better.