Lung Cancer Screening In Canada
Lung cancer is the most common cause of cancer death in Canada and worldwide. Over the past four decades, clinical interventions have had a minimal effect on reducing lung cancer related mortality. The five-year survival rate for patients with lung cancer is currently <18% due to latency of symptom presentation and subsequent delay in early clinical intervention. In the majority of cases, symptoms present after the cancer has advanced to an incurable state. The objective of a lung cancer screening program is to identify patients with high probability of long-term lung cancer, which may benefit from early clinical intervention. This is analogous with established Mammography Screening Programs. Early detection with low-dose computed tomography (LDCT) of the chest can decrease lung cancer mortality by 20%. Cost-effectiveness analysis in Canada showed that LDCT screening is cost-effective and may even be cost –saving when rising costs of cancer treatment is included (i.e. pharmaceuticals). In March 2016, the Canadian Task Force on Preventive Health Care updated the guideline on lung cancer screening to recommend annual screening LDCT for up to 3 consecutive years for adults 55–74 years of age with a minimum 30 pack–year smoking history who are currently smoking or who have quit within the preceding 15 years. Cancer Care Ontario has initiated pilot LDCT screening in three sites using a lung cancer risk prediction model. Other provinces are planning phased programs. Lung cancer screening is a process and not a test, similar to mammography screening. Lung cancer screening programs need to be delivered in controlled health care settings that can identify individuals with sufficient lung cancer risk to benefit from screening and the risk related to the LDCT exam, strategies for effective screening uptake & retention, provision of smoking cessation services, standardized protocol for LDCT imaging, standardized protocol for lung nodule identification, classification, interpretation, reporting and management recommendation, a standardized algorithm to manage incidental findings (i.e. similar to the BI-RAD category system used in Mammography Screening), availability of expertise to diagnose and treat early lung cancer, mechanisms for data collection, recall, outcome evaluation, and quality assurance as well as health economic analysis.
This presentation is divided into 2 sections: 1) clinical need and management, including a review lung cancer screening programs, the risk-benefit of such programs and clinical indications from imaging that initiate clinical intervention, and 2) technical and QC requirements, including LDCT scanner technical requirements, patient dosimetry and comparison with Mammography Screening Programs.