Lung screening in Canada, 2023-24
About this section
This section describes how jurisdictions correspond with individuals after lung screening, and how individuals are notified of their results and invited for follow-up. Appropriate referral and reporting pathways for participants, set methods for notifying primary care providers and/or participants of the results, specification of the organization responsible for program implementation and coordination, and provision of information on benefits and harms allowing eligible individuals to make an informed choice are all elements of organized screening programs (WHO, IARC).
Lung screening pathway
On this page:
Four jurisdictions do not require participants to have a primary care provider (PCP) to access screening; three jurisdictions do require participants to have a primary care provider in order to access screening.
Access to lung screening for participants without a primary care provider
| P/T | PCP required to access screening? | How are unattached patients linked to screening? | How do unattached patients receive their results? (e.g., navigator, screening program, linkage to PCP to manage screening results) | How is a PCP identified if follow-up is required? |
|---|---|---|---|---|
| YT | – | – | – | – |
| NT | – | – | – | – |
| NU | – | – | – | – |
| BC | ✓ | Eligible patients encouraged to reach out to a walk-in clinic or to access a virtual provider such as TELUS Health. Urgent primary care clinics are also supporting attachment on a case-by-case basis. | Patients are only screened once they are attached to a PCP. Results letters are mailed to patients and providers after the scan. | At this time, clients will not be screened without an attached PCP. Work is in progress to implement solutions to serve unattached population. |
| AB* | ✓ | The unattached individual is advised to find a family doctor accepting new patients in their area and make an appointment. A family doctor can be identified through albertahealthservices.ca (click Find Healthcare), by calling Health Link at 811, or at albertafindadoctor.ca.
The individual may also be encouraged to make an appointment at a walk-in clinic. If the individual or their family identifies as First Nations, Métis, or Inuit they can access a doctor through their phone or computer. Call 1-888-342-4822 or visit aivcc.ca (Alberta Indigenous Virtual Care Clinic. |
Not accepting unattached patients^. | N/A |
| SK | – | – | – | – |
| MB | – | – | – | – |
| ON | ✓~ | Ontario Lung Screening Program (OLSP) sites are responsible for attaching eligible people to a PCP if they do not have one. | Referral from a provider is a requirement for a patient to receive a CT scan. Therefore, once someone has been screened in the program, they are not considered to be unattached. All program participants receive results through a phone call with the screening navigator within 2 weeks of their scan. | The PCP is identified prior to the LDCT scan. In addition to sending the referring provider the radiology report, the screening navigator or clerk will send an additional communication every time actionable incidental findings are documented in a participant’s radiology report. |
| QC | No PCP required.** | Volunteer physicians are designated in each region with an allocation of three new patients per physician. These physicians manage incidental findings only. | ||
| NB | No PCP required.‡ | |||
| NS | No PCP required. | Navigator will call with results; mailed letter to follow for patient’s records. | Program will be referring physician for LDCT and manage all communication of results to patients. Working on a pathway to manage referral to specialists and incidental findings. | |
| PE | TBD | TBD | TBD | TBD |
| NL | No PCP required. | NP associated with the program can provide care as it pertains to lung screening positive findings.*** |
*AB: Updated March 2024.
^AB: If a patient loses their PCP in the time between referral and results, patients receive a letter to contact their PCP to discuss their results. A Screening Program team (RN or NP) may contact the patient and support them to find a new PCP. A call may be made to the Primary Care Network or previous Clinic to advocate for a PCP to follow-up.
~ON: If somebody self presents and is found to be eligible, they still need a referral from a doctor or NP to authorize the LDCT scan. Ontario Lung Screening Program (OLSP) sites facilitate attachment and maintain a list of primary care providers willing to assume responsibility for screening referral and management of any actionable incidental findings for eligible participants who do not have a primary care provider.
**QC: A collective prescription was created for unattached patients. Plans are being made to refer unattached patients in need of a follow-up for incidental findings to Primary Care Access Points (“Guichets d’accès première ligne” (GAPs)).
‡NB: To be determined in consultation with Provincial Lung Cancer Screening Implementation Advisory Committee
***NL: Updated April 2024
Lung screening navigation
| P/T | Navigation provided? | Navigation provider (e.g. nurses, nurse practitioners, dedicated navigators) | How is navigation provided? |
|---|---|---|---|
| YT | – | – | – |
| NT | – | – | – |
| NU | – | – | – |
| BC | ✓ | Program navigators (non-clinical) | Individuals interested in screening call the program and a team of centralized program navigators will review their eligibility, enroll eligible participants into the program, and generate a lung screening LDCT referral. Participants are invited to call the program anytime with additional questions/concerns. Navigator also provides smoking cessation counselling for clients who are still smoking. |
| AB | ✓ | Nurse practitioner | Nurse practitioner (NP) reviews all referrals, determines eligibility, communicates back to PCP and patient. If eligible, NP orders LDCT scan and refers patient to Tobacco Cessation Program.
NP reviews LDCT results report and determines Lung-RAD scoring using clinical tool in consultation with radiologists and medical lead. NP notifies patient of result and schedules appointment to meet with patients whose results are unclear or abnormal. NP refers patients with unclear or abnormal results to DI for another LDCT scan and/or to the Alberta Thoracic Oncology Program for further investigation and tests. |
| SK | ✓ | Nurse | A nurse navigator has been hired and is developing the navigation pathway and scope for lung screening. |
| MB | – | – | – |
| ON | ✓ | Dedicated Navigators* | Screening navigators are an important part of the program and support participants from the point of recruitment up to the point of diagnostic assessment.
The screening navigators complete risk assessments, are typically trained as the smoking cessation counsellor, provide navigation for hospital visits, lead the informed participation process, communicate results, schedule follow-up scans, provide reminders for upcoming scans, and facilitate transition to lung diagnostic assessment for suspicious scans. |
| QC | ✓ | Nurse | Nurse at the Provincial Coordination Centre performs initial eligibility assessment and follows up with eligible participants for five months. Also assesses participants in the second screening cycle. The nurse is a resource person to answer questions throughout the process. |
| NB | Will build on existing colon cancer screening program access to coordinator resources.^ | ||
| NS | ✓ | Nurse navigator | End-to-end navigation with a point person for all parts of the screening pathway. Navigation will be consistent across all health zones in the province. |
| PE | ✓ | Respiratory Therapist navigator (proposed) | Respiratory Therapist will screen for eligibility, indicate Lung-RADS score, communicate next steps, ensure connection to the health care system until diagnosis, complete smoking cessation counselling, forward concerns to coordinator and cancer navigator, and indicate and connect to other provincial resources as required (proposed). |
| NL | ✓ | Nurse navigator | Will build on existing navigation supports within the screening program. |
*ON: Ontario Lung Screening Program (OLSP) Navigators may have different training (e.g., nurse, medical radiation technologist (MRT), etc.)
^NB: To be determined in consultation with Provincial Lung Cancer Screening Implementation Advisory Committee
Follow-up for abnormal lung screening results
Provinces and territories have different follow-up methods after an abnormal lung screening test result. Participants receive results through either a phone call, a letter, or from their primary care provider. Follow-up care is initiated and coordinated by either a health care provider, a coordinating centre, or the lung screening program.
| P/T | How do patients receive abnormal screening results (e.g. PCP, mail, online, lung program)? | Who initiates referral to follow-up care provider (e.g. physician, program)? | Who coordinates follow-up appointment (e.g. referring physician, lung program, follow-up care location)? | Rapid diagnosis initiative in place? | Additional details about follow-up process |
|---|---|---|---|---|---|
| YT | – | – | – | – | – |
| NT | – | – | |||
| NU | – | – | – | – | – |
| BC | Letter is mailed from screening program to the patient after the PCP receives the results | Program initiates fast-track referral for diagnostic workup | Designated diagnostic workup teams | ✓ | If no lung cancer was found following diagnostic work-up assessment, the participants will return to surveillance screening by the program |
| AB | Patient receives a letter from the program. The PCP may also meet with them to discuss results (optional). Patients who are signed up on MYAHSCONNECT will also receive a copy through their online personal health portal
Alberta Lung Cancer Screening Program (ALCSP) Nurse practitioner meets with patients whose results are unclear or abnormal |
Nurse practitioner | Nurse practitioner, diagnostic imaging, and Alberta Thoracic Oncology Program (depending on result)
|
✓ | PCP follows up on incidental findings |
| SK | Under development | ||||
| MB | – | – | – | – | – |
| ON | Screening navigator communicates results over the phone within 2 weeks of the scan. Participants are asked to review the Participant Information Sheet given to them on the day of the scan to support the conversation. | Program initiates referral to on-site lung diagnostic assessment team. Navigators facilitate referral on behalf of the referring provider (authorization from the provider included in the referral form). | After being referred for lung diagnostic assessment, screening participants must be evaluated using existing hospital processes for diagnostic workup, staging and establishing treatment plans. | ✓* | An Ontario Lung Screening Program (OLSP) site will accept a screening participant back to screening at the discretion of the physician who conducted the lung diagnostic assessment if the participant is clearly negative (i.e., ruled out) for lung cancer or if the participant’s lung nodules are indeterminate. |
| QC | Letter and phone call | Coordination centre nurses initiate referrals to investigation clinic and physician or specialized nurse practitioner to follow-up on incidental findings | Coordination centre nurse | ✓ | |
| NB^ | – | – | – | – | – |
| NS | Nurse navigator will call with results. PCP will also receive results. Letters will be mailed to patients as well | Lung screening program | Lung screening program | ✓ | Finalizing details for appointment coordination with specialist teams (thoracic surgery, respirology) |
| PE | TBD | TBD | TBD | In development | |
| NL | Letter from screening program | Program will initiate fast-track referral for diagnostic workup through existing thoracic triage | Screening program | ✓ |
*ON: Rapid diagnosis initiative defined as program facilitation of referral to lung diagnostic assessment instead of requesting provider referral.
^NB: To be determined in consultation with Provincial Lung Cancer Screening Implementation Advisory Committee