Lung cancer screening framework for Canada: Frequently asked questions (FAQ) (2014)

November 26, 2014

Find answers to frequently asked questions (FAQ) about Canada’s lung cancer screening framework, released in 2014

1. Why does Canada need a lung cancer screening framework?
In 2013, about 25,500 Canadians were diagnosed with lung cancer and some 20,200 men and women died from the disease. The five-year relative survival rate for lung cancer is 17 per cent.

Lung cancer is the leading cause of death from cancer in Canada and is the second most common cancer in both males and females.

Lung cancer is the leading cause of death from cancer in Canada

In the United States, the National Lung Screening Trial (NLST) found that lung cancer deaths fell by 20 per cent in current and/or former smokers, aged 55 to 74. The smokers had smoked one pack of cigarettes a day for 30 years or the equivalent, and were screened annually for three consecutive years using low-dose spiral computed tomography (LDCT). The trial also found that the number of deaths from any cause fell by seven per cent among this group. Those benefits must be carefully considered along with lung cancer screening’s potential harms and costs.

This framework will help provinces and territories determine if lung cancer screening is right for them. If yes, the framework will help to advance implementing a screening program or initiative. In addition, the framework may help to mitigate risks from private screening by outlining key considerations.

2. How is lung cancer screening different from other kinds of cancer screening?
Screening programs for breast, cervical, and colorectal cancers screen people at average risk of developing those cancers. Instead, lung cancer screening focuses on a defined high-risk population. This type of screening has risks and complications for lower-risk people, such as false positive findings on LDCT, which likely out-weigh any potential benefits. Lung cancer screening through the LDCT test also involves exposure to low levels of radiation. If abnormalities are found, any resulting investigation or treatment could add significant risks.

3. Who could benefit from lung cancer screening?
Based on evidence from the National Lung Screening Trial (NLST), the US Preventive Services Task Force recommends screening only individuals who are considered at high risk of developing lung cancer. The exact elements of who would be considered high risk are not included in this framework and will be determined by individual provinces and territories.

Setting criteria for eligibility to participate in screening requires consideration of multiple factors, besides risk exposure. Ideally, conditions such as age should be standardized across the country, as it is for colorectal cancer screening. However, lung cancer screening programs will likely evolve differently across the provinces and territories to fit their needs for timing and approaches.

4. How does this framework help improve lung cancer survival?
Screening can improve one’s chances of surviving cancer because it can help detect the presence of lung cancer in earlier, more treatable stages. However, there are many factors that contribute to survival, including response to treatment.

This framework can help provide evidence-based information, and inform the consideration or implementation of lung cancer screening in provinces and territories where an initiative is determined necessary and feasible.

5. Why are screening and smoking cessation linked?
Lung cancer screening also offers the opportunity to address prevention by combining screening with programs for quitting smoking. As a result, cessation programs may engage groups of smokers who traditionally were hard to attract.

Also, published and ongoing modeling analyses demonstrate that LDCT lung cancer screening combined with smoking cessation appears to be more cost-effective than screening alone.

6. What does the framework cover that is relevant to a lung cancer screening program?
The framework was informed by the International Association for the Study of Lung Cancer (IASLC) CT Screening task force. The framework lists key components and considerations in the following areas for lung cancer screening:

• Smoking cessation
• Recruitment and eligibility
• Radiological testing
• Diagnostic follow-up and treatment after screening
• Pathology quality and reporting

The framework may not address or resolve some issues and gaps. It is one part of an iterative process.

7. How was the framework developed?
This framework’s statements were developed through an extensive consultation process with pan-Canadian working groups made up of nominated Pan-Canadian Lung Cancer Screening Network members and other expert volunteers. The consultations took place between April 2013 and April 2014 and involved clinicians, pathologists, radiologists, smoking cessation experts, and thoracic surgeons, among others. For more information, please see Appendix A of the framework.

8. As of 2014, are there any lung cancer screening programs currently in practice in Canada?
In March 2013, the Alberta Cancer Foundation invested in a three-year, pilot lung cancer screening program. The program aims to screen 800 Albertans for lung cancer to determine how effective the screening method is and which patients can benefit the most.