Organized screening for lung cancer will save lives and resources in the cancer system

March 23, 2020

Evidence shows that lung cancer caught at an earlier stage has better treatment outcomes

Screening people based on their risk of getting lung cancer can save lives, but unfortunately, organized, jurisdiction-wide lung cancer screening programs for those with a high risk of this disease do not yet exist anywhere in Canada.

Organized screening programs are important now, more than ever, with lung cancer continuing to have the highest mortality rate among all types of cancer.

A new resource developed by the Partnership presents the rationale and value proposition in a standard business case for provinces and territories to implement organized lung screening programs, and it details how it will lead to better outcomes for people with the disease and efficiencies in the cancer system. The business case is available for jurisdictions to adapt and use in their own provincial or territorial contexts to advance lung cancer screening. A Readiness Assessment Toolkit has been created as a complementary resource to support partners in utilizing the business case.

Starting in 2020, the Partnership will be supporting provinces and territories in creating organized lung cancer screening programs in their jurisdictions with a focus on people-specific approaches to increase the accessibility of these programs for First Nations, Inuit and Métis communities and people in other underserviced communities such as those living in rural and remote areas and those with low income.

These efforts will help move forward priority 2 of the Canadian Strategy for Cancer Control (2019-2029) to have cancer diagnosed faster, accurately, and at an earlier stage through evidence-based organized screening programs.

Survival rates increase with earlier detection

Lung cancer is the most commonly diagnosed cancer among people in Canada and this type of cancer kills more people in Canada than colon, breast and prostate cancers combined. Yearly, 29,300 people in Canada are diagnosed with lung cancer and 21,000 die from it.

Stopping smoking continues to be the best thing one can do for their overall health, and for those who’ve quit smoking, getting screened is the only other thing they can do to significantly reduce their lung cancer risk.

Seventy percent of all lung cancers are diagnosed at advanced stages (III and IV). In many cases, the disease progresses over a number of years, giving opportunities for clinical intervention. Five-year survival for advanced-stage lung cancer is less 19 percent. However, if lung cancer is detected at the earliest stage (Stage 1A), the 5-year survival is more than 80 percent.

The number of deaths and utilization of healthcare system resources can be reduced through early detection.

LDCT helps with early detection 

Low-dose computed tomography is a quick and non-invasive way to screen for lung cancer and can catch the disease earlier.

The high mortality rate from lung cancer is strongly correlated to it often being diagnosed in advanced stages when treatment is less effective, and chances of survival are lower. Now, low-dose computed tomography (LDCT) offers a way to detect lung cancer at earlier stages which can lead to improved treatment outcomes.

Yearly, 29,300 people in Canada are diagnosed with lung cancer and 21,000 die from it.

LDCT involves using low-dose radiation to capture detailed images of the lungs. The procedure is quick and non-invasive. Early detection for lung cancer is feasible because LDCT has shown to be clinically effective. Two large randomized controlled trials revealed LDCT screening to reduce deaths from lung cancer by 20 to 24 percent. Furthermore, the number needed to screen (NNS) to prevent one death from lung cancer was estimated to be 255 for LDCT, which is considerably lower compared to other Canadian screening programs.

LDCT is also cost-effective

Lung cancer screening is expected to be cost-effective, and economic modeling shows that LDCT matches with other screening strategies. The Partnership’s OncoSim model projects that over a 20-year time frame, lung cancer screening with LDCT will detect 8,000 to 17,000 more lung cancer cases at Stage I, leading to 6,000 to 14,000 fewer cases at Stage IV, and will result in 5,000 to 13,000 fewer lung cancer deaths.

Five-year survival for advanced-stage lung cancer is less 19 per cent.

Only opportunistic screening exists for lung cancer

Organized screening programs exist across Canada for breast, cervical and colorectal cancers, but organized, jurisdiction-wide lung cancer screening programs have not yet been implemented. Opportunistic screening – where screening occurs in an uncontrolled and unmonitored environment – is already happening. Opportunistic screening is known to result in increased  costs and negative impacts to individuals than would occur with organized screening designed to ensure the right people get the right screening test and follow-up at the right time

Over a 20-year time frame, lung cancer screening with LDCT will result in 5,000 to 13,000 fewer lung cancer deaths.

Opportunity to implement LDCT for organized screening

Most provinces have experience with LDCT lung cancer screening through participation in the Pan-Canadian Early Lung Cancer Detection Study (AB, BC, NS, NL, ON, QC), ongoing research studies (AB, BC) and pilot trials (ON). As outlined in the toolkit, there’s an opportunity to build on that expertise to implement organized LDCT screening effectively in provinces and territories. The Readiness Assessment Toolkit can be used by jurisdictional decision-makers and leaders at cancer agencies and programs.

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