Environmental Scan April 2017 T he Canadian Partnership Against Cancer collects information annually on national provincial and territorial lung cancer screening guidelines strategies and activities ID: 1041143
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1. Lung Cancer Screening in Canada Environmental ScanApril 2017
2. 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.Background2April 2017
3. OutlineLung Cancer Screening Guidelines and StrategiesCanadian Task Force on Preventive Health Care GuidelinesCurrent Strategies for Lung Cancer Screening in Canada Opportunistic Screening Synoptic Reporting for Lung Cancer Pathology Rapid Diagnosis Initiatives for Lung Cancer3April 2017
4. April 20174Lung Cancer Screening Guidelines and StrategiesThere 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.
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 20175
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 smokingFor more information please visit: http://canadiantaskforce.ca/6April 2017
7. Canadian Task Force on Preventive Health Care Guidelines (2016), cont’dAdditional 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 smokingChest 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
8. Current Strategies for Lung Cancer Screening in Canada8Province/TerritoryOrganized Program(Yes/No) If yes, please describeProposal/Business Case/Assessment (Yes/No)If yes, please describeAdvisory Committee (Yes/No)If yes, please describePilot Study (Yes/No)If yes, please describe Other Key Lung Cancer Screening Strategies/Activities YukonNoNoNo No----Northwest TerritoriesNoNoNoNo----NunavutNoNoNoNo----British ColumbiaNoYesBC Cancer Agency has reviewed scientific evidence for high risk screening and is preparing business case for implementation. NoNoVGH-UBC Hospital Foundation, BC Cancer Foundation and Terry Fox Research Institute funded study at VGH to evaluate issues around lung cancer screeningAlbertaNoYesHealth Technology Assessment completed 2015. Decision is to not fund a formal screening program at this time. May be revisited in 2017.NoYesAlberta Cancer Foundation Grant received for pilot project.-------- No information was provided at the time the data was collected.
9. Current Strategies for Lung Cancer Screening in Canada, cont’d9Province/TerritoryOrganized Program(Yes/No) If yes, please describeProposal/Business Case/Assessment (Yes/No)If yes, please describeAdvisory Committee (Yes/No)If yes, please describePilot Study (Yes/No)If yes, please describe Other Key Lung Cancer Screening Strategies/Activities SaskatchewanNoNoYesA committee has been formed to monitor national progress.No----ManitobaNoNoYes 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.
10. Current Strategies for Lung Cancer Screening in Canada, cont’d10Province/TerritoryOrganized Program(Yes/No)If yes, please describeProposal/Business Case (Yes/No)If yes, please describeAdvisory Committee (Yes/No)If yes, please describePilot Study(Yes/No)If yes, please describe Other Key Lung Cancer Screening Strategies/Activities OntarioCancer 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.NoMulti-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.QuebecNoNoYes 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 québécoisNo-------- No information was provided at the time the data was collected.
11. Current Strategies for Lung Cancer Screening in Canada, cont’d11Province/TerritoryOrganized Program(Yes/No)If yes, please describeProposal/Business Case (Yes/No)If yes, please describeAdvisory Committee (Yes/No)If yes, please describePilot Study(Yes/No)If yes, please describe Other Key Lung Cancer Screening Strategies/Activities New BrunswickNoNoNoNo----Nova ScotiaNoYesWorking group reviewed evidence for screening high risk population in Nova Scotia and submitted a recommendation to the Minister of HealthNoNo----Prince Edward IslandNoYes Health PEI is conducting a lung cancer screening feasibility study to assist in program planning and future commitments. YesLung Cancer Action GroupNo----Newfoundland and LabradorNoNoYesA lung screening committee is being established in Fall of 2016. No-------- No information was provided at the time the data was collected.
12. Agency Responsible for Lung Cancer Screening StrategyAgency Responsible for Strategy Implementation YukonGovernment of YukonNorthwest TerritoriesDepartment of Health & Social ServicesNunavutDepartment of HealthBritish ColumbiaBC Cancer Agency AlbertaAlberta Health ServicesSaskatchewanSaskatchewan Cancer AgencyManitobaManitoba Health and CancerCare ManitobaOntarioCancer Care Ontario QuebecDirection générale de cancérologie et Direction générale de santé publique, Ministère de la Santé et des Services sociaux du QuébecNew BrunswickNew Brunswick Cancer Network (NB Department of Health)Nova ScotiaCancer Care Nova Scotia (Nova Scotia Health Authority)Prince Edward IslandHealth PEINewfoundland and LabradorEastern Health, Cancer Care Program12April 2017
13. April 201713Opportunistic 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.
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 201714
15. Opportunistic ScreeningProvince/TerritoryYes/No/UnknownIf yes:Who is ordering LDCT scans?Where is LDCT taking place?YukonNoN/ANorthwest TerritoriesNoN/ANunavutNoN/ABritish ColumbiaYesBCCA (research protocol) and outside of BCCA (ad hoc screening)AlbertaYes1. Family physicians, internists. 2. Both in private and public system on ad hoc basis.SaskatchewanNoN/AManitobaYesThere 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.OntarioYesScreening is occurring through hospital-based initiatives. The locations and extent of other opportunistic screening is unknown.QuebecUnknownN/ANew BrunswickUnknownN/ANova ScotiaYesOn an ad-hoc basisPrince Edward IslandYesOccasionally, however requisitions for LDCT lung scans for lung cancer screening are being declined by Department of Diagnostic Imaging at this time.Newfoundland and LabradorYesThere is currently no mechanism to track or capture the amount of LDCT testing.15*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?
16. Opportunistic ScreeningAre there mechanisms within your province/territory to measure the amount of opportunistic LDCT screening that is occurring (e.g. billing code)?16Province/TerritoryYes/No/UnknownIf yes, please describeYukon--------Northwest TerritoriesNoN/ANunavutNoN/ABritish Columbia--------AlbertaNoN/ASaskatchewanNoN/AManitobaNoN/AOntarioNoN/AQuebecNoN/ANew BrunswickNoN/ANova Scotia--------Prince Edward IslandNoData on this would be captured in the Diagnostic Imaging database (RIS) but not conducting scans at this time.Newfoundland and LabradorNoPotential 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
17. April 201717Synoptic 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.
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 201718
19. Does your province/territory use synoptic reporting for lung cancer pathology?Province/Territory(Yes/No)If yes, please describe. Yukon--------Northwest TerritoriesYes----NunavutNoN/ABritish ColumbiaYesSynoptic reporting is done in some hospitals.AlbertaYes----SaskatchewanNoN/AManitobaNo“Synoptic-like” reporting (not discrete data fields but synoptic format).OntarioYesThe 2013 CAP protocol is used for lung resection.QuébecYesThe implementation is ongoing.New BrunswickYesCAP lung resection checklist for pathology.Nova ScotiaYesA 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 IslandYesThoracic 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 LabradorYesSynoptic template from CAP.19Synoptic Reporting for Lung Cancer Pathology ---- No information was provided at the time the data was collected. N/A: Not applicableCAP: Canadian Association of Pathologists
20. April 201720Rapid 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.
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 201721
22. Rapid Diagnosis Initiatives for Lung CancerProvince/TerritoryRapid 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’) YukonNoN/AN/AN/ANorthwest TerritoriesNoN/AN/AN/ANunavutNoN/AN/AN/ABritish ColumbiaYes1) Vancouver Cancer Centre2) Fraser Valley Thoracic Surgery Group at the Surrey Memorial Hospital (SMH): Rapid Autopilot Program1) 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 pathDate of diagnosis or rule out cancerAlbertaYesThe Alberta Thoracic Oncology Program’s (ATOP) Rapid Assessment Clinics (RACs)Date of referral to RAC for suspicious CT scan or x-rayTBCSaskatchewanNo N/AN/AN/AManitobaNo, but a lung cancer care pathway developed for “In Sixty” initiativeN/AN/AN/AOntarioYesLung/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 screening22Note: 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’dProvince/TerritoryRapid 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’) QuebecYes1) Institut Universitaire de Cancérologie et Pneumologie du Québec’s Guichet de coordination de l’investigation en cancer du poumon2) McGill University Health Centre’s Lung Cancer Navigation Centre’s Rapid Investigation Clinic1) 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 BrunswickNoN/AN/AN/ANova ScotiaYesThe 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 reportDate management decision is madePrince Edward IslandWork underway to develop a diagnostic pathway for lung cancer with targets and reduce the time from suspicion to treatment.N/AN/AN/ANewfoundland and LabradorYes Thoracic Triage Panel of Eastern Health (pilot)Date of receipt of referral to triage panel for patients with diagnostic imaging report suggesting malignancyDate of completion of diagnostic investigations23N/A: Not applicable
24. ReferencePlease 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
25. AcknowledgementsProduction of this environmental scan has been made possible through financial support from Health Canada through the Canadian Partnership Against Cancer.April 201725