Lung Cancer Screening Guidelines Across Canada

1. Lung Cancer Screening Guidelines Across Canada Environmental Scan

2. Background Quarterly, the Canadian Partnership Against Cancer collects information from the provinces/territories and international organizations on the status of population-based lung cancer screening strategies. This information compares current guidelines and evidence-based recommendations in order to identify leading practices. April 2014

3. Presentation Outline • Canadian Task Force on Preventive Health Care Guidelines • Current Evidence in Lung Cancer Screening • Strategies for Lung Cancer Screening in Canada • Summary of Key Activities for Lung Cancer Screening Across Canada April 2014

4. Canadian Task Force on Preventive Health Care Guidelines The Canadian Task Force on Preventive Health Care (2003) recommends the following for lung cancer screening: There is fair evidence to recommend against lung cancer screening for asymptomatic people using chest radiographic examination (D recommendation). There is insufficient evidence (in quantity and/or quality) for the Task Force to make a recommendation for using computed tomography (CT) scanning when screening asymptomatic people for lung cancer. However, there may be other factors which may influence decision-making (I recommendation). For more information please visit: http://canadiantaskforce.ca/ April 2014

5. Current Evidence Supporting Lung Cancer Screening • The U.S. Preventive Services Task Force has issued a final recommendation statement on screening for lung cancer. • Annual screening for lung cancer with low-dose computed tomography (LDCT) is recommended for persons aged 55-80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. • For more information please visit: U.S. Preventive Services Task Force • Findings from the National Lung Screening Trial stated the following: • 20% reduction in mortality after 3 annual screens using low-dose spiral computed tomography in the high risk* group versus the control group. • For summary of scientific evidence and related references with regards to lung cancer screening please visit: Anticipatory Science *high risk is considered those persons ages 55-74 who have a smoking history of 30+ pack years or have quit smoking within the past 15 years. April 2014

6. Current Strategies for Lung Cancer Screening

7. Summary of Key Activities Across Canada Yukon Due to limited resources, the territory does not have a program in place. Northwest Territories There is no formal lung cancer screening program or specified directed activities. Northwest Territories does however actively promote tobacco prevention and cessation program. Nunavut Due to limited resources, the territory does not have a program in place; however, there is a robust tobacco reduction program. April 2014

8. Summary of Key Activities Across Canada British Columbia BC Cancer Agency - Lung Tumour Group has reviewed scientific evidence for screening and presented summary to the Executive Committee. Under discussion to develop and assess options for implementation in BC. Alberta AHS requested a Health Technology Assessment which is underway and report may be available by end of 2014. Alberta Cancer Foundation Grant received for pilot project to develop screening framework. April 2014

9. Summary of Key Activities Across Canada Saskatchewan A committee has been formed although the province prefers to wait until a national consensus has been reached before taking action in this field. Manitoba A working group will be established as needed to continue monitoring the evidence and practice of screening in other jurisdictions. Manitoba will also participate in CPAC initiatives to support development of national guidelines and consensus on screening for lung cancer. April 2014

10. Summary of Key Activities Across Canada Ontario Cancer Care Ontario (CCO) Program in Evidence-based Care (PEBC) Evidence-based Series #15-10: Screening High-Risk Populations for Lung Cancer report has been finalized and is now published on the CCO website at: https://www.cancercare.on.ca/toolbox/qualityguidelines/clin-program/screening-ebs/ The guidelines, developed by CCO’s PEBC and a clinical expert panel, recommend the use of low-dose computed tomography as a screening modality for lung cancer in high risk populations (those 55 to 74 years with a smoking history of  ≥ 30 pack years who currently smoke or have quit within the past 15 years) who are disease-free at the time of screening “through an organized screening program and administered by specialized centres with multi-disciplinary care teams”. Opportunistic screening of asymptomatic individuals is not recommended due to the considerable risks posed to patients outside of an organized program.  Additional research is required to determine the feasibility of an organized lung cancer screening program in Ontario and, to that end, CCO has engaged Sunnybrook Research Institute to conduct this work (including an economic evaluation, communication strategy , and case studies of readiness for CT Lung Screening).

11. Summary of Key Activities Across Canada Quebec • Currently, there is no program in place for lung cancer screening. La Direction québécoise de cancérologie is preparing a summary of evidence for Minister of Health. New Brunswick • Pan Canadian Lung Cancer Screening Guidelines are currently being monitored. • There may potentially be some work in the area similar to Alberta for example, determining the proximity of CT scanners to the population in New Brunswick. • There is interest in identifying how to define the high risk population (New Brunswick is not involved in the Pan Canadian Early Lung Cancer Detection Study). Nova Scotia • Nova Scotia is currently participating in the Pan-Canadian Early Lung Cancer Detection Study. Working group formed to review evidence for high risk screening, analyze evidence within the Nova Scotia context, and to develop a recommendation/business case to Government re: next steps.

12. Summary of Key Activities Across Canada Prince Edward Island Currently, there is no program in place. A committee is evaluating provincial cancer rates and national evidence for screening. Newfoundland/Labrador No program in place. There is an active “Lung cancer diagnostic pathway committee”.  The committee has reviewed the current practices for work-up of abnormal chest imaging for lung cancer diagnosis in Newfoundland. It was decided to implement a triage process, with the goal of streamlining this diagnostic pathway, and at the same time to triage patients very early to treatment. The province is under taking a review of all existing screening programs (cervical, breast, colorectal, cancer genetic screening). The review is expected to be completed by spring There are plans to engage government after the review to discuss lung cancer screening. April 2014

13. Reference Slide Please use the following reference when citing information from this presentation: Cancerview.ca. Lung Cancer Screening Guidelines Across Canada: Environmental Scan. Toronto: Canadian Partnership Against Cancer; [enter date]. Available from: [enter URL link] April 2014