Lung Cancer Screening in Canada

1. Lung Cancer Screening in Canada Environmental Scan April 2017

2. Background 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. April 2017

3. 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 April 2017

4. 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. April 2017

5. 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 2017

6. 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/ April 2017

7. 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/ April 2017

8. Current Strategies for Lung Cancer Screening in Canada ---- No information was provided at the time the data was collected.

9. Current Strategies for Lung Cancer Screening in Canada, cont’d ---- No information was provided at the time the data was collected.

10. Current Strategies for Lung Cancer Screening in Canada, cont’d ---- No information was provided at the time the data was collected.

11. Current Strategies for Lung Cancer Screening in Canada, cont’d ---- No information was provided at the time the data was collected.

12. Agency Responsible for Lung Cancer Screening Strategy April 2017

13. Opportunistic Screening Opportunistic 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. April 2017

14. 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. April 2017

15. Opportunistic Screening Are low dose computed tomography (LDCT) scans being ordered for lung cancer screening* in your province/territory? *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

16. Opportunistic Screening Are there mechanisms within your province/territory to measure the amount of opportunistic LDCT screening that is occurring (e.g. billing code)? ---- No information was provided at the time the data was collected N/A: Not applicable

17. 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. April 2017

18. 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 2017

19. Synoptic Reporting for Lung Cancer Pathology Does your province/territory use synoptic reporting for lung cancer pathology? ---- No information was provided at the time the data was collected. N/A: Not applicable CAP: Canadian Association of Pathologists

20. 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. April 2017

21. 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. April 2017

22. Rapid Diagnosis Initiatives for Lung Cancer 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

23. Rapid Diagnosis Initiatives for Lung Cancer, cont’d N/A: Not applicable

24. 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) April 2017

25. Acknowledgements Production of this environmental scan has been made possible through financial support from Health Canada through the Canadian Partnership Against Cancer. April 2017