Lung cancer screening in Canada: 2021/2022

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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.

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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. Under review 2021

*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