EP1.11-01 Lung Cancer Screening and Canada’s Inuit: A Missed Opportunity

Abstract

Inuit peoples account for 0.2% of Canada’s population. Lung cancer rates in this population are disproportionately high for both genders with Canada’s Inuit having the highest incidence of lung cancer in the world. Outcomes are also poor with median survival for all stages combined in Nunavut being approximately 10 months. Lung cancer screening with low dose CT scan is being implemented in many countries, and a pilot program exists in Ontario, Canada. However, the screening model may not be appropriate for the Inuit. A literature review was performed regarding lung cancer screening, specifically with reference to the Inuit. Several challenges must be considered for implementation of lung cancer screening with the Inuit population. The Prostate, Lung, Colorectal and Ovarian Screening Trial model (PLCO[M2012]) is the risk prediction model used in the Ontario Lung Cancer Screening Pilot for People at High Risk. This requires individuals to be between ages 55-74 and to have smoked daily for at least 20 years during their life. The average life expectancy among Inuit is 72 years, compared to 82 years for Canadians overall. Using this model where the average life expectancy is lower than the upper limit of eligibility restricts its applicability. Smoking rates among this indigenous group are approximately 3 times higher than the rest of Canada, which indicates a clear need for screening where a higher proportion of the population would be eligible. Nunavut is a vast land area of around 2 million square kilometres, with a population of approximately 35,000. The logistics of providing screening in remote communities only connected by air travel is therefore daunting. Other dominant health issues among the Inuit of Nunavut are high rates of tuberculosis, therefore screening CT scans may be further complicated by higher false positive scans requiring established algorithms for management of all abnormal scans. With the Inuit population growing faster than the rest of Canada, yet experiencing a reduced lifespan as compared to other Canadians, there is an opportunity to address the inequity that may be created with the current eligibility model used for screening in Ontario. Furthermore, current recruitment strategies and eligibility assessments are not well suited to this group’s unique background. The current PLCO risk prediction model used in Ontario may not offer the best benefit for screening in this population while careful thought about how this group is recruited is also required to minimize barriers experienced by this vulnerable population.