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Canadian Lung Cancer Screening Guidelines have Changed

Whether you’re a former smoker or currently smoking, the guidelines for lung cancer screening have changed, and you're going to want to know about them.

The Canadian Task Force on Preventive Health Care (CTFPHC) announced on Monday that they’re recommending annual screenings, for three consecutive years for lung cancer, in those who are high risk.

High risk adults are defined as current or former smokers between the ages of 55 and 74-years-old, who quit in the past 15 years, and those who have at least a 30 pack-year smoking history.

"While the prognosis for lung cancer remains poor, we are starting to see the benefit of screening which can detect the disease at an earlier stage when it may respond better to treatment," said Dr. Gabriela Lewin, member of the CTFPHC and chair of the guideline working group.

"As smoking is associated with 85 per cent of lung cancer incidents in Canada, tobacco control and smoking cessation efforts are critical for reducing the morbidity and mortality due to the disease."

Lung cancer is the most common cause of cancer-related deaths, and it is the most common type of cancer for Canadians.

The guidelines suggest to use low dose computed tomography (LDCT), which has a 15 per cent reduction in lung cancer mortality, compared to chest x-rays.

"Screening high risk individuals for lung cancer using low dose CT has the potential to make a significant impact by reducing lung cancer mortality in Canada. I am pleased that this guideline supports the implementation of lung cancer screening," said Gail Darling, Clinical Lead, High Risk Lung Cancer Screening, Cancer Screening, Prevention and Cancer Control, Cancer Care Ontario.

"The development of carefully organized programs for lung cancer screening is required to maximize benefit and minimize potential harms."

CTFPHC released three recommendations when it came to lung cancer screening:

For adults aged 55-74 years with at least a 30 pack-year smoking history, who currently smoke or quit less than 15 years ago, the CTFPHC recommends annual screening with LDCT up to three consecutive years. Screening should only be carried out in health care settings with expertise in early diagnosis and treatment of lung cancer.

o The weak recommendation, resulting from low quality evidence, implies that practitioners should have a discussion with their patients about the benefits and harms of screening for lung cancer with LDCT (including false positives, side effects of invasive follow up testing, and over-diagnosis).

For all other adults, regardless of age, smoking history or other risk factors, the CTFPHC does not recommend screening for lung cancer with LDCT.

o Strong recommendation; very low quality evidence.

The CTFPHC recommends against using chest x-ray to screen for lung cancer, with or without sputum cytology.

o Strong recommendation; low quality evidence.

An estimated 26,600 Canadians were diagnosed with the cancer, and approximately 20,900 died from the disease in 2015.



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