Risk-based lung cancer screening with low-dose computed tomography in a Canadian province: Evaluation results of a demonstration project in Quebec, Canada

Background A Lung Cancer Screening Demonstration Project using low-dose computed tomography (LDCT) was launched in Quebec, Canada to inform province-wide lung cancer screening implementation. This study analyses key performance indicators of the screening pathway. Methods High-risk smokers and ex-smokers were referred or self-referred for screening. Eligibility was based on the Prostate, Lung, Colorectal and Ovarian (PLCOm2012 noRace ) 6-year risk (≥2%). Lung-RADS 3 and Lung-RADS 4 rates, lung cancer detection and false-positive rates, and early-stage cancer proportion (TNM stages I and II), along with other performance indicators, were computed for the two first screening rounds. Results Between June 2021 and November 2022, 8416 individuals were referred to the project, and 4422 were eligible (53.4%; target ≥50%). The first 3200 participants were included in the study. Mean PLCOm2012 noRace risk was 5.2%. In round 1, Lung-RADS 4 occurred in 6.8% of participants (target ≤10%), with a cancer detection rate of 1.7% (target ≥1.5%), and a false-positive rate of 5.3% (target ≤10%). In round 2, Lung-RADS 4 rate was 4.0% (target ≤5%), with a cancer detection rate of 0.8% (target ≥0.7%), and a false-positive rate of 3.2% (target ≤5%). Early stage cancers accounted for 85.2% in round 1 and 84.2% in round 2 (target ≥70%). Adherence to the next screening among Lung-RADS 1 or 2 participants was ≥81% across both rounds (target ≥70%). Overall, 91.1% of screen-detected cancers received curative treatment (target ≥65%). Conclusion Results showed good performance strengthening evidence on key indicators pertaining to benefits and harms of lung cancer screening within a provincial public health care system.