Screening

Lung Cancer Screening Receives a Positive Recommendation!

The Canadian Task Force on Preventive Health Care now recommends screening using low-dose CT scans in high-risk adults aged 55-74 years who are current or former smokers with a smoking history of at least 30 pack-years, defined as the average number of packs smoked daily multiplied by the number of years of smoking. This is a big step in the fight against lung cancer, which is the leading cause of cancer related death in Canada. [Canadian Cancer Statistics, 2015]

Lung Cancer Screening Saves Lives

The earlier lung cancer is diagnosed, the better the opportunity for curative treatment. Much of the great improvement that has been seen in survival in cancers such as breast, colorectal and cervical have been due to finding the cancers earlier through regular testing, even of those at just moderate risk, such as from age. However, almost half (48%) of lung cancer diagnoses are made only when the cancer is already at stage 4, the most advanced stage, meaning it has already spread outside of the lung, and a further 27% of cases are diagnosed only at stage 3. [Canadian Partnership Against Cancer, Lung Cancer in Canada: A supplemental system performance report. May 2011. p 10] The newest screening method, low-dose computed tomography (LDCT) screening, offers much greater promise by yielding a more comprehensive view of the lung tissue while exposing patients to only 20% of the normal CT scan radiation. An expert panel convened by the Canadian Partnership Against Cancer in 2011 to review lung cancer screening reported that a comprehensive program of LDCT screening in Canadians at risk for lung cancer could be expected to save more than 1,200 lives per year, based on results of the National Lung Screening Trial in the US. [Canadian Partnership Against Cancer, Lung Cancer Screening - Expert Panel: Summary of Existing and New Evidence, September 22, 2011. p 33-34]

Lung Cancer Screening Saves Money

In Canada, the Pan-Canadian Early Detection of Lung Cancer Study examined both how to incorporate lung cancer screening into our health care systems, and how much it would cost. This study found that screening has the potential to save the health care system a significant amount of money. In this study, the average cost to screen individuals at high risk for developing lung cancer using LDCT was $453 for the initial 18 months of screening following a baseline scan. If a patient can be treated using curative surgery, the average cost was $33,344 over two years. This is significantly lower than the average per person cost of $47,792 used in treating advanced-stage lung cancer with chemotherapy, radiotherapy or supportive care alone. [Cressman S, Lam S, Tammemagi MC et al, Resource Utilization and Costs During the Initial Years of Lung Cancer Screening with Computed Tomography in Canada. Journal of Thoracic Oncology. 9:10 October 2014] The recommendation for lung cancer screening is a significant one. To date, no province has adopted a comprehensive lung cancer screening program. Lung Cancer Canada believes that lung cancer screening can save lives and lessen the significant burden on the healthcare system. Lung Cancer Canada calls on all provinces and territories to adopt screening programs that, at the very least, target patients with the highest risk of lung cancer.

FAQ

Currently there is no formal lung cancer screening program in Canada, however there are pilot programs underway for which you may be eligible. As healthcare is under provincial jurisdiction, each province will need to design and adopt their own formal program. Hospitals and clinics across the country do have teams and the expertise to conduct lung cancer screening so speak to your family physician to get a referral or call your provincial cancer association to help identify a centre with expertise.

To assess your level of risk and get more info, visit MyCancerIQ.

For more information on Ontario's pilot program, view the CCO Lung Cancer Screening Program FAQs.

The Canadian Task Force for Preventative Health recommends screening using low-dose CT scans in high-risk adults aged 55-74 years who are current or former smokers with a smoking history of at least 30 pack-years, defined as the average number of packs smoked daily multiplied by the number of years of smoking. If you have quit smoking, you must have quit within the last 15 years. This recommendation is aligned with other expert and cancer agency recommendations as well.

Lung cancer screening provides a chance for lung cancer to be diagnosed early at a more curable stage. The National Lung Screening Trial showed that three annual screens using LDCT may reduce lung cancer mortality by 20%. [Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395-409]

Lung cancer screening provides a chance for lung cancer to be diagnosed early at a more curable stage. The National Lung Screening Trial showed that three annual screens using LDCT may reduce lung cancer mortality by 20%.
The National Lung Screening Trial (NLST) showed that the number needed to screen (NNS) for lung cancer is 320. This means that out of of 320 people in the high risk population that are screened for lung cancer, one person will be diagnosed with lung cancer. [National Lung Screening Trial Research Team. Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395–409] In comparison, the NNS for breast cancer is 720.

CT scans carry the risk of exposure to radiation and a positive scan could lead to an invasive procedure such as a lung biopsy. Due to this, screening should be monitored and controlled in order to minimize harms and maximize the benefits through appropriate follow-up. Lung cancer screening is only recommended to those that have been identified as high risk.

Currently no province has a formal screening program. However hospitals and clinics across the country have teams and the expertise to conduct lung cancer screening. Speak to your family physician to get a referral or call your provincial cancer association to help identify a centre with expertise.

If you are screened and there is a positive result, you and the medical team will have a discussion to determine the appropriate follow-up testing and monitoring plan. It is important to note that a positive result is not a diagnosis of lung cancer. Nodules that are detected may not be cancerous and may never develop into cancer. This is why it is important to work with your medical team to determine the best course of action when you get a positive screening result.

References and Resources:

Canadian Cancer Statistics, 2015
Canadian Medical Association Journal: Canadian Task Force on Preventive Health Care Recommendations for Lung Cancer Screening
Canadian Partnership Against Cancer: Press Release and Viewpoint
Canadian Partnership Against Cancer, Lung Cancer in Canada: A supplemental system performance report
Canadian Partnership Against Cancer, Lung Cancer Screening - Expert Panel: Summary of Existing and New Evidence
Lung Cancer Risk Calculator
Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening
Resource Utilization and Costs during the Initial Years of Lung Cancer Screening with Computed Tomography in Canada