Organized Lung Cancer Screening Pilot: Informing a Province-wide Program in Ontario, Canada.

Abstract Background Lung cancer is the leading cause of cancer deaths in Ontario. The National Lung Screening Trial demonstrated that screening with low-dose computed tomography (LDCT) reduces lung cancer mortality. Methods In June 2017, Ontario Health (Cancer Care Ontario) initiated a pilot for lung cancer screening to inform implementation of a province-wide initiative. The screening pathway includes targeted recruitment strategies, the Tammemagi risk prediction model (PLCOm2012) to determine eligibility, opt-out smoking cessation services for all current smokers, use of the Lung-RADSTM scoring system to guide abnormal results management and screening navigators providing end-to-end support. Referral criteria include being ages 55-74 and a current or former daily cigarette smoker for ≥20 years, while the screening eligibility criterion is a PLCOm2012 risk ≥2% in 6 years. Selected results of the interim pilot evaluation are presented. Four hospitals contributed data in the first year of the pilot. Results During 2017-2018, 4,205 Ontarians were recruited, 3,234 risk assessments were conducted and 2,151 (66.5%) individuals were eligible for screening. Baseline LDCT scans were performed in 1,624 (50.2%). Diagnostic evaluation in 120 (7.4%) identified 28 (1.7%) with lung cancer, and proportions of stage I-II and stage III-IV were 71% and 29%, respectively. Of those recruited, 1,443 (34.3%) were smokers and 1,326 (91.9%) accepted smoking cessation services. Conclusions The pilot is the largest in Canada and aligns with International Agency for Research on Cancer standards for population-based, organized cancer screening. Recruitment of high-risk individuals, high rates of smoking cessation program acceptance and detection of early-stage cancers are demonstrated.