Lung cancer screening in Canada: 2021/2022
About this section
There is one fully implemented organized lung screening program in Canada. This section describes provinces and territories plans to implement lung cancer screening activities.
Plans to implement lung cancer screening programs in Canada
Three provinces have begun screening high-risk individuals for lung cancer through a provincial program or pilot and seven provinces are planning for implementation of an organized lung cancer screening program. BC launched a fully implemented province-wide organized screening program in spring 2022. In Ontario, lung cancer screening is delivered at four sites across the province through an organized program. Pilots began in Quebec in 2021 and in Alberta in 2022.
The Canadian Task Force on Preventive Health Care recommends screening adults aged 55-74 years old with a 30 pack-year smoking history who currently smoke or quit less than 15 years ago are screened with low dose computed tomography (LDCT) annually 3 consecutive time. Many jurisdictions are using evidence based risk assessment calculators to determine eligibility in their screening programs.
Status of lung cancer screening programs in Canada, June 2022
*BC’s CPAC funded project has been completed as of March 2022
Implementation status of lung cancer screening programs in Canada, June 2022
|P/T||Agency responsible||No current organized lung cancer screening activities||Planning for implementation||Pilot||Partially implemented||Fully implemented|
|YT||Health and Social Services||✓|
|NT||Department of Health and Social Services||✓|
|NU||Department of Health||✓|
|BC||BC Cancer, Provincial Health Services Authority||✓|
|AB||Alberta Health Services||✓|
|SK||Saskatchewan Cancer Agency||✓|
|MB||CancerCare Manitoba & Manitoba Health, Seniors, and Active Living||✓|
|ON||Ontario Health (Cancer Care Ontario)||✓*|
|QC||Ministère de la santé et des services sociaux (MSSS) [Ministry of Health and Social Services]||✓|
|NB||New Brunswick Cancer Network, New Brunswick Department of Health||✓|
|NS||Nova Scotia Health Cancer Care Program (NSH CCP)||✓|
|NL||Provincial Cancer Care Program, Eastern Health||✓|
ON: *Fully implemented at 4 sites (anyone in Ontario can access screening at one of these sites); Working with the Ministry of Health to expand.
Levels of implementation status (to show incremental implementation progress by jurisdiction):
1. No current organized lung cancer screening activities: No plans for lung cancer screening implementation (i.e. “status quo” opportunistic lung cancer screening activities)
2. Planning for implementation: Conducting environmental scanning, gathering requirements to determine approach for implementation (i.e. preparing/submitting business cases, forming advisory committees) and/or planning for pilots/programs
3. Pilot: Pilot has been implemented to offer lung screening to high-risk individuals. Pilots may include time-bound screening activities that do not have confirmed sustainable funding.
4. Partially implemented: An organized lung cancer screening program has rolled out in certain sites or for certain populations across the jurisdiction. Programs may be considered partially implemented if screening is being phased-in over time by gradually increasing the capacity of screening sites or if plans are in place to implement screening at additional screening site locations after initial implementation. Partial implementation has secured sustained funding to offer long-term organized screening.
5. Fully implemented: A fully implemented organized lung cancer screening program for people at high risk of lung cancer, which is available jurisdiction-wide and embeds a culturally safe approach to care. Note: An organized program would include elements such as eligibility criteria, quality assurance mechanisms, patient navigation, participant recall, diagnostic follow up, integration of smoking cessation etc.
Lung cancer screening activities
Many jurisdictions have initiated lung screening strategies, such as preparing business cases and convening advisory committees and working groups. Ten provinces and one territory participated in the development of the Lung Cancer Screening with LDCT: Standard Business Case, which was released in 2020. Nine jurisdictions are being funded by the Partnership to plan for or implement lung cancer screening. Activities listed here may be current or historical activities to prepare for organized lung cancer screening.
Lung cancer screening activities
|P/T||Standard business case||Research study||Proposal/Business case||Advisory committee/ Working group||Announcement||Pilot||CPAC funded project||Other activities|
ON: *Transition from a pilot to a program
Descriptions of lung cancer screening activities
|P/T||Description of lung cancer screening activities|
|YT||· Standard Business Case: Participated in the development of CPAC’s Standardized Lung Cancer Screening Business Case|
|BC||· Standard Business Case: Participated in the development of the Standardized Lung Cancer Screening Business Case
· Research Study: Research study started in 2016.
· Proposal/Business Case: Developed in 2016, updated in July 2018.
· Advisory Committee/Working Group: Working groups includes: LDCT Imaging Working Group, Diagnostic Working Group and Patient Pathway Working Group to prepare for transition into province-wide screening program.
· Announcement: Announced an organized, province-wide lung cancer screening program in September 2020. The program will be launched in 2022.
|AB||· Standard Business Case: Participated in the development of CPAC’s Standardized Lung Cancer Screening Business Case
· Research Study: Screening activity in Alberta was a part of a research protocol. The project was completed in 2019
· Business case: Developed a new AB lung cancer screening program business case, and submitted it for final approval. CPAC provided a grant in support of planning activities.
|SK||· Standard Business Case: Participated in the development of CPAC’s Standardized Lung Cancer Screening Business Case. Work is currently underway to further develop a Northern Saskatchewan, and Saskatchewan specific Lung Cancer Screening business case and analysis.
· Advisory Committee/working group: In order to ensure a collaborative approach to the co-creation of a Lung Cancer Screening program, a project governance and shared decision-making models was established to allow full collaboration and working relationships between project stakeholders. This model includes the development of a Provincial Steering Committee, Community and Clinical working groups. This structure will promote opportunities for collaboration among community members, clinicians, and provincial stakeholders. The level of engagement from stakeholders, with the co-creation of a decision framework, will be monitored and evaluated using qualitative methods and with engagement quality indicators to ensure program success.
· In support of the creation of a Lung Cancer Screening pilot, a request for ongoing operational funding was submitted to the Saskatchewan Ministry of Health.
· Pre-implementation planning activities are currently underway with the support of CPAC provided funding.
|MB||· Standard Business Case: Participated in the development of CPAC’s Standardized Lung Cancer Screening Business Case
· Advisory Committee/Working Group: The Lung Cancer Screening Advisory Group was established in 2016 to determine the feasibility of programmatic lung screening in Manitoba.
· CPAC Funded Project: The primary objective of the project is to complete all activities in preparation for a fully organized lung cancer screening program in Manitoba, using a phased-in implementation approach.
|ON||· Standard Business Case: Participated in the development of CPAC’s Standardized Lung Cancer Screening Business Case
· Proposal/Business Case: A health technology assessment in 2015 used the MISCAN-lung microsimulation model to generate expected outcomes of eligibility scenarios. The preferred cost-effective scenario involved screening people ages 55 to 75 who had smoked at least 40 pack-years and were current or former smokers who had quit within the past 10 years.
· Advisory Committee/Working Group: Advisory Committee includes: Multidisciplinary Expert Panel, Radiologist Quality Assurance Expert Panel, Smoking Cessation Advisory Committee, Physician Leads Working Group, Regional Primary Care Leads and Regional Indigenous Cancer Leads Working Group, Radiology Template Expert Panel. Note: Committees are only engaged as needed.
· Pilot: The pilot phase of lung cancer screening in Ontario has ended. 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, a shift towards earlier stage at diagnosis and high participant satisfaction.1 A final pilot evaluation is in progress.
· Reference: 1) 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: doi.org/10.1016/j.athoracsur.2020.07.051.
· CPAC Funded Project: For a description of CPAC funded projects, please see Key highlights.
· Other activities: On April 1, 2021, the pilot transitioned to the Ontario Lung Screening Program (OLSP). The four sites that participated in the pilot continue to offer organized lung cancer screening through the OLSP using current policies and processes and Ontario Health (Cancer Care Ontario) looks forward to adding more lung cancer screening sites across the province as part of the OLSP.
|QC||· The implementation of a provincial lung cancer screening pilot project in a real healthcare context began on June 1, 2021 in 8 establishments in Quebec. The objective is to verify, in the socio-health context of Quebec, whether the parameters defined allow the performance standards required for lung cancer screening by TAFD to be reached.
· Proposal / Cost-benefit analysis: A proposal was submitted in April 2019. Approval by the Minister of Health of the implementation of a pilot project for lung cancer screening in January 2021.
· It is expected that in the summer of 2021, the first participants can begin to be tested within the framework of the project.
· Minimum of 3000 participants required, 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. References will be provided by primary care physicians (family doctor and IPS), self-referentials, specialists.
· Pilot project governance committees have been set up: tactical committee, radiologists committee, smoking cessation advisory committee and steering committee in each pulmonary cancer network, demonstration project evaluation committee.
· A rigorous evaluation process for the demonstration project is underway with partners.
|NB||· Standard Business Case: Participated in the development of CPAC’s Standardized Lung Cancer Screening Business Case
· CPAC Funded Project: The primary goal of this initiative is to gather data and complete the NB Lung Cancer Screening Implementation Plan.
|NS||· Standard Business Case: Participated in the development of CPAC’s Standardized Lung Cancer Screening Business Case
· Proposal/Business Case: Developed in 2015 and submitted to government. The document put forward an evidence informed proposal for development and implementation of an organized lung screening program for Nova Scotia.
· Updated Proposal/Business Case for a Lung Cancer Prevention & Early Detection Program submitted to government in September 2021.
· Advisory Committee/Working Group: Formed working group in April 2019 to identify opportunities to minimize ad hoc screening (in absence of a formal screening program) and for revision of the Nova Scotia business case for a formal lung screening program.
|PE||· Standard Business Case: Participated in the development of CPAC’s Standardized Lung Cancer Screening Business Case|
|NL||· Standard Business Case: Participated in the development of CPAC’s Standardized Lung Cancer Screening Business Case
· Advisory Committee/Working Group: Established in 2016. Advisory committee is starting work but are waiting for the national business case.
Next: Pilots and studies