Lung Cancer Screening in Canada
Environmental Scan
April 2017
• The Canadian Partnership Against Cancer collects information annually on national, provincial and territorial lung cancer screening guidelines, strategies, and activities.
• This scan summarizes the data collected and is intended to provide information on policy and practice.
Background
2April 2017
Outline
Lung Cancer Screening Guidelines and Strategies Canadian Task Force on Preventive Health Care Guidelines Current Strategies for Lung Cancer Screening in Canada
Opportunistic Screening Synoptic Reporting for Lung Cancer Pathology Rapid Diagnosis Initiatives for Lung Cancer
3April 2017
April 20174
Lung Cancer Screening Guidelines and Strategies
There are currently no organized lung cancer screening programs in Canada; however, some provinces and territories have initiated lung cancer screening strategies, such as preparing business cases, convening advisory committees, and planning or implementing pilot studies.
Lung Cancer Screening Guidelines and Strategies – Highlights
Current Strategies for Lung Cancer Screening in Canada (refer to slides #8-11)• No provincially organized lung cancer screening programs have
been implemented, although Ontario is preparing to pilot organized lung cancer screening for high risk individuals. Business cases are under development or have been submitted to health ministries in four provinces. Lung cancer screening advisory committees have been formed or are in development in six provinces. Alberta has received a grant for a lung cancer screening pilot project.
April 20175
Canadian Task Force on Preventive Health Care Guidelines (2016)
The Canadian Task Force on Preventive Health Care (2016) recommends annual screening with LDCT up to three consecutive times for adults aged 55-74 with at least a 30 pack-year* smoking history who currently smoke or quit less than 15 years ago.
*Pack-year is defined as the average number of cigarette packs smoked daily multiplied by the number of years smoking
For more information please visit: http://canadiantaskforce.ca/
6April 2017
Canadian Task Force on Preventive Health Care Guidelines (2016), cont’d
Additional lung cancer screening recommendations by the Canadian Task Force on Preventive Health Care (2016) include: Low dose computed tomography (LDCT)
• For all other adults, regardless of age, smoking history or other risk factors, who do not have at least a 30 pack-year* smoking history or who quit more than 15 years ago, routine screening is not recommended.
*Pack-year is defined as the average number of cigarette packs smoked daily multiplied by the number of years smoking
Chest x-ray (CXR)• Chest x-ray is not recommended for lung cancer screening, with or without
sputum cytology.
For more information please visit: http://canadiantaskforce.ca/
7April 2017
Current Strategies for Lung Cancer Screening in Canada
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Province/Territory
Organized Program(Yes/No)
If yes, please describe
Proposal/Business Case/Assessment
(Yes/No)If yes, please describe
Advisory Committee (Yes/No)
If yes, please describePilot Study (Yes/No)
If yes, please describe
Other Key Lung Cancer Screening
Strategies/Activities
Yukon No No No No ----Northwest Territories No No No No ----
Nunavut No No No No ----
British Columbia No
YesBC Cancer Agency has
reviewed scientific evidence for high risk
screening and is preparing business case for implementation.
No No
VGH-UBC Hospital Foundation, BC Cancer
Foundation and Terry Fox Research Institute
funded study at VGH to evaluate issues around lung cancer screening
Alberta No
YesHealth Technology
Assessment completed 2015. Decision is to not fund a formal screening
program at this time. May be revisited in 2017.
No
YesAlberta Cancer
Foundation Grant received for pilot project.
----
---- No information was provided at the time the data was collected.
Current Strategies for Lung Cancer Screening in Canada, cont’d
9
Province/Territory
Organized Program(Yes/No)
If yes, please describe
Proposal/Business
Case/Assessment (Yes/No)
If yes, please describe
Advisory Committee (Yes/No)
If yes, please describe
Pilot Study (Yes/No)If yes, please describe
Other Key Lung Cancer Screening
Strategies/Activities
Saskatchewan No No
YesA committee has been
formed to monitor national progress.
No ----
Manitoba No No
Yes An Advisory Committee was
established in 2016 to explore the feasibility and
cost of a lung cancer screening program in
Manitoba. Work is expected to be completed in fall 2017.
No
- Funding of Champix- CancerCare Manitoba is exploring how its clinical smoking cessation program can be implemented in all regions of the province.
---- No information was provided at the time the data was collected.
Current Strategies for Lung Cancer Screening in Canada, cont’d
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Province/Territory
Organized Program(Yes/No)
If yes, please describe
Proposal/Business Case
(Yes/No)If yes, please
describe
Advisory Committee (Yes/No)
If yes, please describe
Pilot Study(Yes/No)If yes, please describe
Other Key Lung Cancer Screening
Strategies/Activities
Ontario
Cancer Care Ontario is preparing to pilot organized
lung cancer screening for people at high risk. Planning and preparations by Cancer
Care Ontario and pilot sites are nearing completion in
anticipation of initiating screening in early FY 2017/18
at Health Sciences North, Lakeridge Health as well as The Ottawa Hospital with Renfrew
Victoria Hospital.
No
Multi-disciplinary Expert Panel was convened in
October 2015. Panel has endorsed the
screening pathway, eligibility criteria, pilot site
requirements and the pilot evaluation plan.
Implementation pilot is planned of organized lung
cancer screening for people at high risk at
selected pilot sites (See Organized Program)
Pilot sites will embed smoking
cessation services in the screening
pathway.
Quebec No No
Yes L’Institut d’excellence en santé et services sociaux
(INESSS) a le mandat d’évaluer la pertinence du
dépistage du cancer du poumon dans le contexte du système de soins québécois
No ----
---- No information was provided at the time the data was collected.
Current Strategies for Lung Cancer Screening in Canada, cont’d
11
Province/Territory
Organized Program(Yes/No)
If yes, please
describe
Proposal/Business Case (Yes/No)
If yes, please describe
Advisory Committee (Yes/No)
If yes, please describe
Pilot Study(Yes/No)If yes, please describe
Other Key Lung Cancer Screening Strategies/Activities
New BrunswickNo No No No ----
Nova Scotia
No
YesWorking group reviewed
evidence for screening high risk population in Nova Scotia and submitted a recommendation to the
Minister of Health
No No ----
Prince Edward Island
No
Yes Health PEI is conducting a
lung cancer screening feasibility study to assist in
program planning and future commitments.
YesLung Cancer Action Group No ----
Newfoundland and Labrador No No
YesA lung screening
committee is being established in Fall of 2016.
No ----
---- No information was provided at the time the data was collected.
Agency Responsible for Lung Cancer Screening Strategy
Agency Responsible for Strategy Implementation
Yukon Government of Yukon
Northwest Territories Department of Health & Social Services
Nunavut Department of Health
British Columbia BC Cancer Agency
Alberta Alberta Health Services
Saskatchewan Saskatchewan Cancer Agency
Manitoba Manitoba Health and CancerCare Manitoba
Ontario Cancer Care Ontario
Quebec Direction générale de cancérologie et Direction générale de santé publique, Ministère de la Santé et des Services sociaux du Québec
New Brunswick New Brunswick Cancer Network (NB Department of Health)
Nova Scotia Cancer Care Nova Scotia (Nova Scotia Health Authority)
Prince Edward Island Health PEI
Newfoundland and Labrador Eastern Health, Cancer Care Program
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April 201713
Opportunistic ScreeningOpportunistic screening is defined as spontaneous screening of asymptomatic individuals that occurs outside of organized screening programs. Given that the Canadian Task Force on Preventive Health Care guidelines (2016) recommends lung cancer screening within organized programs only, it is important to monitor the extent to which opportunistic screening is occurring.
Opportunistic Screening – Highlights
Opportunistic Screening (refer to slides #15 and 16)• Opportunistic screening for lung cancer with LDCT scans is known to
be occurring in seven provinces. No province or territory has a method of measuring the amount of opportunistic LDCT screening, but some provinces may have the ability to collect this information in the future.
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Opportunistic Screening
Province/Territory
Yes/No/Unknown
If yes:1. Who is ordering LDCT scans?2. Where is LDCT taking place?
Yukon No N/A
Northwest Territories No N/A
Nunavut No N/A
British Columbia Yes BCCA (research protocol) and outside of BCCA (ad hoc screening)
Alberta Yes 1. Family physicians, internists. 2. Both in private and public system on ad hoc basis.
Saskatchewan No N/A
Manitoba Yes There is no mechanism to track the number of LDCT scans being requested and completed. However, through discussion with radiologists, we know referrals for LDCT are being made.
Ontario Yes Screening is occurring through hospital-based initiatives. The locations and extent of other opportunistic screening is unknown.
Quebec Unknown N/A
New Brunswick Unknown N/A
Nova Scotia Yes On an ad-hoc basis
Prince Edward Island Yes Occasionally, however requisitions for LDCT lung scans for lung cancer screening are being declined by Department of Diagnostic Imaging at this time.
Newfoundland and Labrador Yes There is currently no mechanism to track or capture the amount of LDCT testing.
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*Lung cancer screening is defined as screening of asymptomatic individuals. Do not include LDCT scans ordered for other purposes such as lung cancer diagnosis in individuals with prior x-ray abnormality, follow-up, etc.N/A: Not applicable
Are low dose computed tomography (LDCT) scans being ordered for lung cancer screening* in your province/territory?
Opportunistic Screening
Are there mechanisms within your province/territory to measure the amount of opportunistic LDCT screening that is occurring (e.g. billing code)?
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Province/Territory Yes/No/Unknown If yes, please describe
Yukon ---- ----
Northwest Territories No N/A
Nunavut No N/A
British Columbia ---- ----
Alberta No N/A
Saskatchewan No N/A
Manitoba No N/A
Ontario No N/A
Quebec No N/A
New Brunswick No N/A
Nova Scotia ---- ----
Prince Edward Island No Data on this would be captured in the Diagnostic Imaging database (RIS) but not conducting scans at this time.
Newfoundland and Labrador
No Potential exists to harvest dosage information from PACS to count Low Dose Chest CT’s (Low Dose <= 1.5 mSv). Currently being investigated.
---- No information was provided at the time the data was collected N/A: Not applicable
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Synoptic Reporting for Lung Cancer Pathology
Synoptic reporting for lung cancer pathology refers to a standardized electronic report meant to improve quality of reporting for lung cancer pathology. The completeness and reliability of lung cancer pathology reporting is an important component of lung cancer diagnostic procedures.
Synoptic Reporting for Lung Cancer Pathology – Highlights
Synoptic Reporting for Lung Cancer Pathology (refer to slide #19)• Nine provinces and territories currently use synoptic reporting for
lung cancer pathology. Five provinces reported that they use the synoptic template from the Canadian Association of Pathologists (CAP) or a modified version of the CAP synoptic template.
April 201718
Does your province/territory use synoptic reporting for lung cancer pathology?Province/Territory (Yes/No) If yes, please describe.
Yukon ---- ----
Northwest Territories Yes ----
Nunavut No N/A
British Columbia Yes Synoptic reporting is done in some hospitals.
Alberta Yes ----
Saskatchewan No N/A
Manitoba No “Synoptic-like” reporting (not discrete data fields but synoptic format).
Ontario Yes The 2013 CAP protocol is used for lung resection.
Québec Yes The implementation is ongoing.
New Brunswick Yes CAP lung resection checklist for pathology.
Nova Scotia Yes A modified CAP recommended synoptic report for lung cancer has been prepared and it is in the final stage of reviewing. An approved synoptic report was put in place for clinical practice in 2016.
Prince Edward Island Yes Thoracic care is not offered on PEI . However a pathology synoptic report has been developed and is used by some to report on lung biopsies (malignant and benign) based on the CAP resection template.
Newfoundland and Labrador Yes Synoptic template from CAP.
19
Synoptic Reporting for Lung Cancer Pathology
---- No information was provided at the time the data was collected. N/A: Not applicableCAP: Canadian Association of Pathologists
April 201720
Rapid Diagnosis Initiatives for Lung Cancer
A rapid diagnosis initiative for lung cancer is defined as any initiative implemented to shorten the average wait time from clinical suspicion of lung cancer to diagnosis. Patients typically enter rapid diagnosis initiatives at the time of referral for diagnostic imaging and exit at the date of diagnosis.
Rapid Diagnosis Initiatives for Lung Cancer – Highlights
Rapid Diagnosis Initiatives for Lung Cancer (refer to slide #22 and 23)• Six provinces have a rapid diagnosis initiative for lung cancer.
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Rapid Diagnosis Initiatives for Lung Cancer
Province/Territory
Rapid diagnosis initiative in the
province/territory (Y/N)
Name and/or Location of Initiative(s)
Point of entry into the rapid diagnosis initiative for patients (e.g. ‘date of receipt of
referral for patients with abnormal imaging’)
Point of exit out of the rapid diagnosis initiative for patients (e.g.
‘date of diagnosis or rule out of cancer’)
Yukon No N/A N/A N/A
Northwest Territories No N/A N/A N/ANunavut No N/A N/A N/A
British Columbia Yes
1) Vancouver Cancer Centre2) Fraser Valley Thoracic Surgery Group at the Surrey Memorial Hospital (SMH): Rapid Autopilot Program
1) Date of referral to VCC for suspicious CT or CXR2) All patients presenting at SMH with abnormal chest x-rays, CT scans or any other issue identified by the radiologist as at risk for lung malignancy enter into the care path
Date of diagnosis or rule out cancer
Alberta YesThe Alberta Thoracic Oncology Program’s (ATOP) Rapid Assessment Clinics (RACs)
Date of referral to RAC for suspicious CT scan or x-ray TBC
Saskatchewan No N/A N/A N/A
ManitobaNo, but a lung cancer care pathway developed for “In Sixty” initiative
N/A N/A N/A
Ontario Yes Lung/Thoracic Cancer Diagnostic Assessment Programs (DAPs)
For all DAPs: Date of receipt of referral for patients with an abnormal chest CT-scan or chest x-ray; In addition, for DAPs located at lung cancer screening pilot site hospitals – date of receipt of referral for screening participants with a LDCT scan result that is a Lung RADS™ 4A, 4B or 4X.
For all DAPs: Ranges from date of diagnosis (or rule-out of cancer) to post-op.In addition, for DAPs located at lung cancer screening pilot site hospitals – if no cancer is found or indeterminate nodules are identified screening participants may return to screening
22
Note: For the purposes of the scan, a rapid diagnosis initiative for lung cancer is defined as any initiative implemented to shorten the average wait time from clinical suspicion of lung cancer to diagnosis. N/A: Not applicable
Rapid Diagnosis Initiatives for Lung Cancer, cont’d
Province/Territory
Rapid Diagnosis Initiative in the province/territory (Y/N)
Name and/or Location of Initiative(s)
Point of entry into the rapid diagnosis initiative for
patients (e.g. ‘date of receipt of referral for patients with
abnormal imaging’)
Point of exit out of the rapid diagnosis
initiative for patients (e.g. ‘date of diagnosis or rule out of cancer’)
Quebec Yes
1) Institut Universitaire de Cancérologie et Pneumologie du Québec’s Guichet de coordination de l’investigation en cancer du poumon
2) McGill University Health Centre’s Lung Cancer Navigation Centre’s Rapid Investigation Clinic
1) First significant date (abnormal chest x-ray or date of referral from physician for suspicion of lung cancer)
2) Date of receipt of initial referral for suspected lung cancer
1) Date of diagnostic confirmation 2) Date of diagnosis confirmation, date of treatment beginning
New Brunswick No N/A N/A N/A
Nova Scotia Yes
The Nova Scotia Health Authority’s Program of Care for Cancer is piloting “Early Notification of Suspicious Lung Lesions” at several regional facilities.
Date of abnormal chest imaging report
Date management decision is made
Prince Edward Island
Work underway to develop a diagnostic pathway for lung cancer with targets and reduce the time from suspicion to treatment.
N/A N/A N/A
Newfoundland and Labrador Yes Thoracic Triage Panel of Eastern Health (pilot)
Date of receipt of referral to triage panel for patients with diagnostic imaging report suggesting malignancy
Date of completion of diagnostic investigations
23N/A: Not applicable
Reference
Please use the following reference when citing information from this presentation:
Canadian Partnership Against Cancer. Lung Cancer Screening in Canada: Environmental Scan [Internet]. Toronto (ON): Canadian Partnership Against Cancer; 2017 [cited (Enter Date Accessed – formatted as YYYY MM)]. Available from: (Enter Link)
24April 2017
Acknowledgements
Production of this environmental scan has been made possible through financial support from Health Canada through the Canadian Partnership Against Cancer.
April 201725