Canadian Task Force launches new recommendation for high risk population
OTTAWA, ON, March 7, 2016 – Today the Canadian Task Force on Preventive Health Care (CTFPHC) released a new guideline that recommends annual screening (up to three consecutive years) for lung cancer in high risk1 adults aged 55-74 years using low dose computed tomography (LDCT). Guidelines are published in the Canadian Medical Association Journal (CMAJ).
Lung cancer is the most common cause of cancer-related death and most commonly diagnosed cancer among Canadians. Survival rates are among the lowest for all types of cancer in Canada. An estimated 26,600 Canadians were diagnosed and approximately 20,900 died from the disease in 2015.
“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.” A recent study found a 15 per cent reduction in lung cancer mortality associated with screening using LDCT compared to chest x-ray.
The guideline, developed by the CTFPHC, an independent body of primary care and prevention experts, examined the best and most current scientific evidence related to screening tests to formulate the following key screening recommendations:
- 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.
- 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.
- Strong recommendation; very low quality evidence.
- The CTFPHC recommends against using chest x-ray to screen for lung cancer, with or without sputum cytology.
- Strong recommendation; low quality evidence.
Lung Cancer Screening in Canada
To date, there are no organized lung cancer screening programs in Canada as this is a new recommendation. The CTFPHC notes that LDCT scans and such expertise in early diagnosis and treatment are not currently accessible in certain regions of Canada and this is a consideration for policy-makers moving forward.
To assist interested provinces and territories in developing lung cancer screening programs, the Canadian Partnership Against Cancer (“the Partnership”) facilitated the development of the Lung Cancer Screening Framework for Canada, which considers issues of eligibility, testing, follow-up diagnostics and the inclusion of smoking cessation services.
“The Partnership supports the recommendation for screening high risk adults. It is imperative that screening be done in controlled and monitored conditions, as the Task Force recommends, in order to limit the risks of false positives, to ensure appropriate follow-up and to help us gather information to maximize the benefits of lung cancer screening,” said Dr. Heather Bryant, Vice President, Cancer Control at the Partnership.
“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.”
Please find below the link to the Canadian Partnership Against Cancer’s resources on lung cancer screening in Canada, including the Lung Cancer Screening Framework for Canada, in English and French:
Screening Framework and other resources.
For the complete report and details on the CTFPHC’s findings and recommendations and accompanying patient and clinician knowledge translation tools, please visit: www.canadiantaskforce.ca
About the Canadian Task Force on Preventive Health Care
The Canadian Task Force on Preventive Health Care (CTFPHC) has been established to develop clinical practice guidelines that support primary care providers in delivering preventive health care. The mandate of CTFPHC is to develop and disseminate clinical practice guidelines for primary and preventive care, based on systematic analysis of scientific evidence.
1High risk is defined as current or former smokers who quit within the past 15 years and who have at least a 30 pack-year smoking history.
2Smoking is often measured in “pack-years” which is the average number of packs smoked daily and the number of years of smoking. For example, individuals who smoked 1 pack a day (20 cigarettes) for 30 years, or 2 packs a day for 15 years, would both have 30 pack-year history.