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.

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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.

April 201721

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

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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