Lung cancer screening in Canada: 2021/2022
About this section
This section describes various lung screening pilots and studies that have been conducted in Canada.
Lung screening pilots and studies in Canada
Lung screening pilots in Canada
Six individual lung screening pilots and studies have been implemented in Canada. These initiatives include two provincial pilots, a hospital pilot, and three research studies. The Lung Cancer Screening Demonstration Project in Quebec is ongoing, but all other pilots and studies are complete.
Ontario Lung Cancer Screening Pilot for People at High Risk
| Title | Ontario Lung Cancer Screening Pilot for People at High Risk* |
|---|---|
| Purpose of the study/pilot | To assess how to best implement organized lung cancer screening for people at high risk in Ontario. |
| Start and end date | June 2017 – March 2021 |
| # of individuals recruited | More than 13,000 people recruited throughout the duration of the pilot (June 2017 – March 2021). Recruited/referred individuals undergo risk assessment to determine if they are eligible for screening. Note: Number of people recruited was impacted by the COVID-19 pandemic. |
| Study/Pilot inclusion criteria | Criteria: Current/former smokers ages 55-74 who have smoked cigarettes daily for at least 20 years, with ≥2.0% risk of developing lung cancer over the next 6 years as determined by risk assessment using the PLCOm20212 risk prediction model. |
| Guideline inclusion criteria | · Age: 55-74 · > 20 years smoking history |
| Risk prediction model criteria | Age, education, family history of lung cancer, body mass index, personal history of cancer and chronic obstructive pulmonary disease, smoking status, smoking duration, smoking intensity, smoking quit-time |
| Results | Interim evaluation results published in 2020. Final results are expected in 2021. The interim evaluation of the first year of the pilot demonstrated: · Successful recruitment of people at high risk · High rates of smoking cessation program acceptance · Strong cancer detection rate results · A shift towards earlier stage at diagnosis · High participant satisfaction |
| Principal investigator | Ontario Health (Cancer Care Ontario) |
| Reference (if the study has been published) | Reference for interim evaluation results: Darling GE, Tammemägi MC, Schmidt H, Buchanan DN, Leung Y, McGarry C, Rabeneck L, Organized Lung Cancer Screening Pilot: Informing a Province-wide Program in Ontario, Canada, The Annals of Thoracic Surgery (2020), DOI: 10.1016/j.athoracsur.2020.07.051 |
*The information on this pilot was obtained in January 2018 through phone interview with initiative representatives, and updated in 2021.
BC Lung Screen Trial/Pan-Canadian Early Detection of Lung Cancer Extension Project/International Lung Screen Trial
| Title | BC Lung Screen Trial/Pan-Canadian Early Detection of Lung Cancer Extension Project/International Lung Screen Trial* |
|---|---|
| Purpose of the Study/Pilot | · Compare PLCOm2012 1.5% 6-year lung cancer risk versus USPSTF2013 age and pack years criteria for inclusion. · Evaluation of air pollution and genetic susceptibility as lung cancer risk factors in addition to PLCOm2012 · Prospective evaluation of PanCan Lung Nodule protocol · Randomized trial of manual versus CAD reading of screening LDCT |
| Start and end date | July 2016-2021 (5-year trial) |
| # of individuals recruited | 4,800 (expected) (2,100 in Vancouver, 2,000 in 5 sites in Australia, 800 in Hong Kong) |
| Study inclusion criteria | 1) USPSTF2013 guideline OR 2) >1.5% risk of developing lung cancer over the next 6 years |
| Guideline inclusion criteria | · Age: 55-80 · Current or former smokers · > 20 years smoking history |
| Risk prediction model criteria | Age, education, ethnicity, family history of lung cancer, BMI, chronic obstructive pulmonary disease status, smoking duration, smoking intensity, smoking quit-time, and personal history of cancer |
| Results | · 2138/2000 recruited in BC completed in August 2019 · 3.2% lung cancer so far · PLCOm2012 criteria 15.8% more sensitive than USPSTF2013 criteria screening an equal number of people |
| Principal investigator | Dr. Stephen Lam, Dr. John Mayo, Dr. John Yee |
| Reference (if the study has been published) | Ann Am Thorac Soc. 2020. 17(4):503-512. DOI: 10.1513/AnnalsATS.201902-102OC. |
*The information on this study was obtained in January 2018 through phone interview with initiative representatives, and updated in 2021.
Alberta Lung Cancer Screening Research Study
| Title | Alberta Lung Cancer Screening Research Study* |
|---|---|
| Purpose of the Study/Pilot | To gain expertise in screening as well as develop resources and processes to scale up to a larger program. |
| Start and end date | April 2015 (start date) – recruitment ended in 2017 |
| # of individuals recruited | 800 |
| Study/ Pilot inclusion criteria | 1) NLST criteria OR 2) >1.5% risk of developing lung cancer over the next 6 years |
| Guideline inclusion criteria | · Age: 55-75 · ≥30 pack-year · Quit ≤ 15 years ago |
| Risk prediction model criteria | Age, education, ethnicity, family history of lung cancer, BMI, chronic obstructive pulmonary disease status, smoking duration, smoking intensity, smoking quit-time, and personal history of cancer |
| Results | Follow up complete. Some results published; more are pending. |
| Principal investigator | Alain Tremblay |
| Reference (if the study has been published) | Taghizadeh et al. Tobacco use and motivation to stop smoking among long-term smokers who are ineligible for lung cancer screening. Lung Cancer 2017 Tremblay et al. A Randomized Controlled Study of Integrated Smoking Cessation in a Lung Cancer Screening Program. J Thor Onc. 2019. jto.org/article/S1556-0864(19)30359-4/fulltext Tremblay et al. Application of Lung-Screening Reporting and Data System Versus Pan-Canadian Early Detection of Lung Cancer Nodule Risk Calculation in the Alberta Lung Cancer Screening Study. JACR 2019 Tremblay et al. Two-Year Follow-Up of a Randomized Controlled Study of Integrated Smoking Cessation in a Lung Cancer Screening Program. JTOCRR 2020. Tammemagi et al. Comparison of USPSTF 2013 versus PLCOm2012 lung cancer screening eligibility criteria (International Lung Screening Trial). In PRESS 2021 Tremblay et al. Development and application of an electronic synoptic report for reporting of low-dose computed tomography lung cancer screening examination. |
*The information on this study was obtained in January 2018 through phone interview with initiative representatives, and updated in 2021.
Pan Canadian Early Detection of Lung Cancer Study
| Title | Pan Canadian Early Detection of Lung Cancer Study* |
|---|---|
| Purpose of the Study/Pilot | · Prospectively assess the effectiveness of web-based risk prediction model for enrolling individuals into a CT screening study. The risk prediction model used was a prototype of the PLCOm2012 model. · Cost implication of risk-based lung cancer screening · Determine the role of autofluorescence bronchoscopy to detect lung cancer in the central airways · Determine the incremental value of spirometry and blood biomarkers for lung cancer risk assessment |
| Start and end date | September 2008 – 2016 with ongoing follow-up in some sites |
| # of individuals recruited | 2537 |
| Study/ Pilot inclusion criteria | ≥ 2% risk of developing lung cancer over the next 6 years |
| Guideline inclusion Criteria | · Age: 55-75 · Current or former smokers · > 20 years smoking history |
| Risk prediction model criteria | Age, smoking duration, pack-years, family history of lung cancer, education level, body-mass index, chest x-ray in the past 3 years, history of chronic obstructive pulmonary disease |
| Results | · Web-based risk assessment tool is easy to implement in English or French · Risk prediction tool is highly efficient to identify high risk individuals for LDCT screening · LDCT screening is cost-effective: $20,724 (in 2015 Canadian dollars) per quality-adjusted life-year gained · Autofluorescence bronchoscopy is not a useful adjunct to LDCT · Spirometry and Pro-surfactant protein B can improve the accuracy of risk prediction model |
| Principal investigator | Dr. Stephen Lam and Dr. Ming-Sound Tsao |
| Reference (if the study has been published) | · J Clin Oncol. 2009.27(17):2787-97. DOI: 10.1200/JCO.2008.19.4233 · Cancer Prev Res. 2011; 4:552-61. DOI: 10.1158/1940-6207.CAPR-10-0183. · N Engl J Med. 2013; 369:910-919. DOI: 10.1056/NEJMoa1214726. · J Thorac Oncol. 2017: 12:1210-1222. DOI: 10.1016/j.jtho.2017.04.021. · Lancet Digital Health. 2019; 1:e353-62. DOI: 10.1016/S2589-7500(19)30159-1. |
*The information on this study was obtained in January 2018 through phone interview with initiative representatives, and updated in 2021.
Pilot Study by the Centre universitaire de santé McGill (Quebec)
| Title | Pilot Study by the Centre universitaire de santé McGill (Quebec)* |
|---|---|
| Purpose of the Study/Pilot | To detect lung cancer early in high risk individuals in Quebec |
| Start and end date | September 2018 – September 2020 (2-year pilot) |
| # of individuals recruited | 300 |
| Study/ Pilot inclusion criteria | INESSS guidelines |
| Guideline inclusion criteria | · Age: 55-74 · Current or former smoker with PLCO risk score ≥ 2% |
| Risk prediction model criteria | Age, education, ethnicity, family history of lung cancer, BMI, chronic obstructive pulmonary disease status, smoking duration, smoking intensity, smoking quit-time |
| Results | – |
| Principal investigator | |
| Reference (if the study has been published) | N/A |
*This project is independent from the pilot being evaluated for implementation by the Ministère de la santé et des services sociaux.
Lung Cancer Screening Demonstration Project in Quebec
| Title | Lung Cancer Screening Demonstration Project in Quebec |
|---|---|
| Purpose of the Study/Pilot | To detect lung cancer early in high risk individuals in Quebec |
| Start and end date | June 1, 2021 to June 2024, including the filling of the document relating to the evaluation of the project. |
| # of individuals recruited | 3000 |
| Study/Pilot inclusion criteria | INESSS guidelines People aged 55 to 74, smokers or ex-smokers, who have quit for less than 15 years, but have smoked for more than 20 years |
| Guideline inclusion criteria | People aged 55 to 74, smokers or ex-smokers, who have quit for less than 15 years, but have smoked for more than 20 years |
| Risk prediction model criteria | Age, education, ethnicity, family history of lung cancer, BMI, chronic obstructive pulmonary disease status, smoking duration, smoking intensity, smoking quit-time Current or former smoker with PLCO risk score ≥2% |
| Results | In progress |
| Principal investigator | Ministry of Health and Social Services, under the leadership of a tandem doctor and leader manager of the IUCPQ |
| Reference (if the study has been published) | N/A |
*Request from the MSSS to IUCPQ-UL to be the leader of the project and through the Quebec Pulmonary Cancer Network