Lung Cancer Screening Pilot

Lung cancer is the leading cause of cancer death for women and men in Ontario. In 2016, an estimated 7,100 people died of lung cancer in Ontario, which is more than the number of people who died of breast, colorectal and prostate cancer combined.

The five-year relative survival ratio for people diagnosed with lung cancer in Ontario from 2008 to 2012 was 18 percent, showing little improvement over the past decade. 2    It has been poor because people are usually diagnosed with lung cancer when the disease is at an advanced stage.

Cancer Care Ontario is introducing a Lung Cancer Screening Pilot for People at High Risk using low-dose computed tomography (a low-dose CT scan). Lakeridge Heath in Oshawa is one of three hospitals in Ontario taking part in the pilot, along with The Ottawa Hospital and Health Sciences North in Sudbury.

About Low-Dose Computed Tomography (Low-Dose CT Scan)

Cancer Care Ontario recommends using a low-dose CT scan to screen people at high risk of getting lung cancer through an organized screening program. This recommendation is based on evidence generated by the National Institute of Health's National Lung Screening Trial, a randomized controlled trial with more than 50,000 participants. 3

The trial demonstrated that people at high risk of lung cancer who were screened annually for three years with a low-dose CT scan experienced a 20 per cent relative reduction in lung cancer mortality over six years, compared to people who were screened annually for three years with chest x-ray. Screening using a low-dose CT scan can detect cancers at an early stage, when treatment is more likely to be successful. 

Who is eligible for the pilot?

People who are ages 55 to 74 and have smoked cigarettes daily for at least 20 years (not necessarily consecutive) may be eligible for Cancer Care Ontario's Lung Cancer Screening Pilot for People at High Risk.

If you have patients who meet these criteria, you can refer them to your nearest pilot site at Lakeridge Health in Oshawa to complete a risk assessment by telephone to determine eligibility. Eligible participants will be offered screening using a low-dose CT scan of the chest.

Here is a referral form.  

People who aren't eligible for the pilot:

Your patients should NOT be referred to the Lung Cancer Screening Pilot if they:

  • Have previously been diagnosed with lung cancer;
  • Are under surveillance for lung nodules;
  • Have experienced hemoptysis of unknown etiology in the past year; or
  • Have experienced unexplained weight loss of more than five kilograms in the past year.

Research evidence does not currently support screening for lung cancer in populations other than those at high risk due to a history of heavy smoking.

Screening is not appropriate for people with suspected lung cancer. If your patient is demonstrating symptoms of lung cancer, follow the Program in Evidence-Based Care's guidelines for referral of suspected lung cancer and Cancer Care Ontario's lung cancer pathway

How the Screening Pilot works:

The Lung Cancer Screening Pilot for People at High Risk will have the benefits of an organized screening program and will facilitate participant recall and follow-up in a manner similar to the Ontario Breast Screening Program.

Screening navigators will be in place at each pilot site to support screening participants, provide information about lung cancer screening (including benefits and harms), provide screening results and book follow-up appointments.

The pilot site is responsible for:

  • Determining eligibility for screening by conducting a risk assessment;
  • Empowering people to make informed decisions about participating in screening;
  • Providing smoking cessation support;
  • Conducting a baseline low-dose CT scan and ongoing routine annual screening and/or follow-up of nodules if follow-up is recommended by the reporting radiologist;
  • Providing navigation support to the participant through the screening pathway;
  • Informing referring physicians and the primary care physician of screening results, incidental findings and next steps; and
  • Enabling seamless transition to a Lung Diagnostic Assessment Program for assessment and/or surveillance of scans with suspicious findings. 

Smoking Cessation

People who stop smoking greatly reduce their risk of disease and early death. Smoking Cessation services will be offered to all current smokers who are referred to the Lung Cancer Screening Pilot for People at High Risk. These services will be offered at the pilot site at Lakeridge Health in Oshawa and will include a counselling session during the same visit as their low-dose CT scan. 

 General Resources

 Patient Resources

References:

  1.  Cancer.ca. [Internet]. Toronto: Canadian Cancer Statistics 2016. Toronto, ON: Canadian Cancer Society, 2016; [cited 2016 Oct 15] Available here.
  2. Cancercare.on.ca [Internet]. Toronto: Cancer Care Ontario. Ontario Cancer statistics 2016. [updated 2016; cited 2016 Oct 24] Available here.
  3. National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. NEJM 2011; 365(5):395-409.