Abstract

Objectives:Lung cancer is a leading cause of cancer-related death in Canada. Early detection can improve outcomes and despite recommendations from the Canadian Task Force on Preventive Health Care to screen patients who are 55 to 74 years old and have a 30+ pack-year history, formal screening programs are rare in Canada. Our goal was to determine if screening is being performed in a representative Canadian population, if recommendations are being followed, and how screening impacts lung cancer stage at diagnosis and prognosis.Methods:A retrospective chart review was performed to identify patients either screened for lung cancer or imaged due to lung cancer symptoms in Eastern Newfoundland between 2015 and 2018. Age, smoking history, screening modality, diagnosis, cancer stage, and mortality were recorded.Results:Under 6.0% of the eligible population were screened for lung cancer with only 28.13% meeting age and smoking criteria and being screened appropriately with low-dose CT. However, 70% of patients that had lung cancers found by screening met age and smoking screening criteria. While lung cancer detection rates were similar, screening detected cancer in patients at an earlier stage (50% Stage 1) compared to patients who were not screened (20% Stage 1). Patients who were screened had an improved prognosis.Conclusions:Physicians are opportunistically screening for lung cancer, but not consistently following screening guidelines. As screening is sensitive, leads to earlier stage diagnosis, and has a mortality benefit, implementation of an organized screening program could increase quality assurance and prevent many lung-cancer related deaths.

Highlights

  • Lung cancer is the leading cause of cancer-related death in Canada.[1]

  • In 2014, the Canadian Task Force on Preventive Health Care (CTFPHC) recommended screening using 3 annual LDCT scans in high-risk individuals—those aged 55 to 74 who are current smokers or quit less than 15 years ago with a 30+ pack-year history.[2]. These recommendations were based on the National Lung Screening Trial (NLST), one of the first to assess low-dose CT (LDCT) for lung cancer screening, which found a 20% mortality benefit over screening with radiography.[5]

  • We estimated that 8421 people would be eligible for lung cancer screening based on CTFPHC recommendations in our catchment area based on age demographics, smoking habit, and proportion of smokers meeting the criterion based on our data.[16,17]

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Summary

Introduction

Lung cancer is the leading cause of cancer-related death in Canada.[1]. Approximately 85% of lung cancer cases can be attributed to a smoking history and heavier use associated with greater risk.[2]. The Pan-Canadian Early Detection of Lung Cancer (PanCan) study, demonstrated that screening with LDCT can identify more cancers at earlier stages.[6]

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