The Lung Cancer Screening Demonstration Project offers a set of services to Quebecers aged 55 to 74 who are at high risk of developing the disease to screen for lung cancer and reduce the risk of developing it or dying from it. Participants in this project must meet a number of eligibility requirements. The project started on June 1, 2021, at seven designated project sites.
Lung cancer screening is done by annual low-dose computed tomography (CT scans). Screening is performed to identify lung cancer in people who appear healthy, before they show signs or symptoms of the disease. It allows cancers to be detected at an early stage. This increases the chances of a cure.
The results of the screening of the first 3,000 participants in the project will guide the decision about the continuation of the project and possibly its expansion into a full provincial program at additional institutions across the province.
The project has three major goals:
- Reducing the risk of death from lung cancer since the main goal of the project is to reduce the risk of death from lung cancer by detecting cancers at an early stage of their development.
- Detecting lung cancer with annual low-dose CT chest scan, the main medical test used in the project.
- Reducing the risk of developing lung cancer The best way to reduce your risk of lung cancer and other diseases related to tobacco is to quit smoking. The program offers smoking cessation support to all smokers who come into contact with project workers.
The project consists of several services.
Low-dose screening computed tomography
Low-dose screening computed tomography is the main medical test of the project. Annual low-dose screening computed tomography is the best method to screening for lung cancer. It is the only screening test that can reduce the number of deaths from lung cancer.
Low-dose CT scan is also known as CT or CAT scan. It is an imaging technique whose aim is to detect abnormalities, such as cancer.
How the CT scan works
The CT scanner used consists of a short tunnel into which the patient slides while lying on a table.
The examination creates detailed images of the body’s organs using X-rays and computer programs. The images reveal the scanned organs and allow to detect any abnormalities.
The examination procedure
When you book your appointment, you will receive further instructions on how the examination will be carried out.
The screening CT scan does not require injection of contrast media. The examination takes between 10 and 15 minutes. You will not feel any pain during the examination.
The examination is conducted by a medical imaging technologist, who manages the equipment and ensures that you are comfortable, in order to produce quality images.
For more information about the procedure, contact the Lung Cancer Screening Demonstration Project coordination centre.
Results of the CT scan
Once the examination is over, the CT scan is reviewed by a radiologist.
There are two potential outcomes:
- The radiologist detects an abnormality or has a doubt when reading your scan: your scan result is abnormal. This means that you will need to be monitored more closely or have further tests. However, it does not prove that you have lung cancer.
- The radiologist does not detect any abnormalities when reading your CT scan: your CT scan result is normal. Even if you participate in screening and your CT scan is normal, you may have cancer that was not detected on the CT scan. Cancer can also develop after your scan. You should see a doctor immediately if you notice any symptoms of lung cancer developing.
Support to stop smoking
Quitting smoking significantly reduces the risk of developing many diseases, including some cancers, and of dying prematurely. Quitting smoking also improves your overall health and quality of life. Support to helping you quit smoking will be offered to you throughout your participation in the project.
If the radiologist finds an abnormality or has doubts when reading your scan, closer follow-ups may be needed. The radiologist may also order further tests to clarify the result.
If you need further tests, follow the instructions you receive from the demonstration project staff and your doctor.
If you have any preferences about where to have your further tests, discuss them with your doctor, the specialized nurse practitioner or the demonstration project nurse.
Types of additional examinations
The different types of additional tests are performed for specific reasons. If you need to have further tests, you will only receive those that are required in your situation. The following list presents some examples of additional tests.
- Contrast-enhanced computed tomography (CT): a CT scan in which a contrast medium is injected into your arm.
- PET-Scan: an imaging technique that shows the activity of cancer cells and inflammation.
- Bronchoscopy: insertion of a flexible tube into the trachea and bronchi to allow the doctor to see inside them. During this examination, the pneumologist may take tissue samples from the trachea, bronchi or any tumour that is detected.
- Biopsy: the removal of cells or tissue from the lung.
- Magnetic resonance imaging (MRI): an examination that allows the radiologist to see inside organs using magnetic fields.
Preparation for further examinations
If you need further tests, pay attention to the instructions you received when you made your appointment.
Like many people, you may be worried about having tests related to the detection of lung cancer. Don’t be afraid to talk openly about your fears and concerns with your doctor or nurse. You can also get information and support from the Lung Cancer Screening Demonstration Project coordination centre. You should also find out how long it will take to get the results of your tests.
Participation in the project is voluntary. It is important to be well informed about what screening entails for you before deciding whether or not to participate in the screening project. To help you make your choice, see the section Benefits, risks and limitations of CT screening.
Admission to the project
Check your eligibility for the project
In general, the Lung Cancer Screening Demonstration Project is intended for people:
- between the ages of 55 and 74;
- who are at high risk of lung cancer, namely those who are in one of the following two situations:
- have smoked continuously or off-and-on for at least 20 years,
- smoked continuously or discontinuously for at least 20 years and quit less than 15 years ago;
- who are insured by the Québec public health insurance plan.
You may meet these criteria and not be eligible. Your eligibility will be confirmed by the professionals at the project coordination centre.
People who have already had lung cancer are not eligible for the Lung Cancer screening Demonstration Project. They need personalized medical follow-up that is adapted to their situation.
Discuss your possible participation with a health care professional
If you meet the eligibility criteria, your doctor or your primary care specialized nurse practitioner can refer you to the coordination centre. If you agree to participate, your family doctor or primary care specialized nurse practitioner will need to complete the Demande de référence : dépistage du cancer du poumon form (in French only) . Your family doctor or primary care specialized nurse practitioner can consult the section intended for health professionals on the website of the Ministère de la Santé et des Services sociaux (in French only) for more information.
If you do not have access to a family doctor or primary care specialized nurse practitioner, you can email firstname.lastname@example.org or call 1‑844‑656‑4312, to find out if you are eligible for the project.
Your eligibility for the demonstration project will be checked using a questionnaire developed especially for this purpose.
Obtaining information about the project
Once your eligibility has been confirmed, the coordinating centre will provide you with full information about the low dose CT Lung Cancer Screening Demonstration Project.
Once your eligibility has been verified, you will need to give your consent for participation in the project to the coordinating centre nurse. The nurse will ask you the questions on the Consent to participate in the Lung Cancer Screening Project form.
Getting support to quit smoking
Quitting smoking is the best way to reduce your risk of getting lung cancer. If you smoke, you will be offered support for quitting. However, if you choose to decline the stop smoking support, you can still be screened.
Getting a scan appointment
Once your eligibility for the project has been confirmed, you will be given an appointment for the CT scan at the participating facility closest to where you live.
Getting the CT scan
- Go to the facility on the date and time of your appointment with:
- your health insurance card (required),
- your hospital card (optional);
- Get your screening CT scan.
Receiving the results of your screening scan
You will receive the results of your screening scan by mail or email a few days after the exam. In some cases, a nurse from the coordination centre will contact you to explain your result. By this time, your family doctor will have already received the result of your screening CT scan. If you do not have a family doctor, you will be assigned a specialist doctor or specialized nurse practitioner.
You may need further tests. However, this does not mean that you have lung cancer.
Benefits, risks and limitations
All people who are screened for lung cancer are encouraged to get informed about the benefits, risks and limitations of lung cancer screening by CT scan. Each person will be able to make an informed decision about whether or not to be screened, based on their values and preferences. It is therefore expected that some people will accept while others will decline to be screened.
Consult the outil d'aide à la décision (in French only)
Benefits of screening
Participation in the Lung Cancer Screening Demonstration Project has various benefits:
- reducing the risk of dying from lung cancer since screening detects cancers at an early stage;
- reducing the risk of other health problems stemming from lung cancer as screening detects cancers at an early stage;
- reducing the use of tobacco and the danger of relapse, since all smokers will be provided support to stop smoking when they come into contact with project workers;
- possible discovery and management of abnormalities other than lung cancer. Low-dose screening CT scans can be used to visualize organs in the trunk. The examination may therefore reveal incidental anomalies in the lung or other organs, but which are not lung cancer and which develop with little or no symptoms. Management of these abnormalities can prevent complications.
Risks of screening
Participation in the Lung Cancer Screening Demonstration Project can also have risks.
- Waiting periods and anxiety, especially when further tests are needed.
- Unnecessary examinations due to unexpected findings.
- Potential overdiagnosis. Overdiagnosis is the discovery of a cancer or other abnormality that would never have been detected without screening, and which would never have had any health or life consequences, for example, a cancer that develops very slowly or a harmless cancer. As it still remains impossible to differentiate between harmless and fatal cancers, all cancers are treated. This means that a given screening project participant could:
- receive treatment that was not necessary;
- experience the side effects of those treatments;
- have to live with a cancer diagnosis;
- have frequent medical appointments to check that the cancer does not return;
- experience anxiety about the cancer.
- Exposition to radiation. A CT scan is an imaging technique that produces a series of X-ray images. As with all X-ray examinations, radiation is emitted. However, the risk of developing cancer from the radiation emitted during the low-dose CT scan is considered to be low for people participating in the project.
Limitations of the project
Participation in the lung cancer screening demonstration project does not guarantee that :
- all lung cancers will be detected;
- all participants in the project who get lung cancer may survive it.
Among participants who receive a normal screening CT scan result, some may still develop cancer. This can happen in the following circumstances:
- the cancer was not visible on the scan or was not detected;
- the cancer had not yet developed when the scan was taken;
It is impossible to know in advance exactly which of the participants will have benefits or risks from screening.
Some participants will have to travel for their CT scan and therefore incur travel costs.
CT screening scans performed at any of the screening centres participating in the project, as well additional examinations, are free of charge for all eligible patients on the Québec public health insurance plan.
Travel costs, if any, are the responsibility of the participant.
Lung Cancer Screening Demonstration Project Coordination Centre
The Lung Cancer Screening Demonstration Project Coordination Centre organizes the activities of the project for the entire province. It provides the following services:
- Call back referrals to:
- verify their eligibility for the project and the absence of contraindications,
- refer to a project stop smoking resource or an external resource (I quit now ),
- provide complete information on the benefits, risks and limitations allowing participants to make an informed choice about their participation in the project;
- obtains informed consent from participants;
- communicates the results of the screening scans;
- sends annual reminders;
- ensures the management of participants who received an abnormal result on their screening CT scan;
- response to questions and comments from individuals about the project.
The coordination centre does not respond to medical requests. If needed, please consult your physician or the Info-Santé 811 line.
Participating screening centres
Since June 1, 2021, lung cancer screening is offered at seven Québec facilities as part of a stringently managed Lung Cancer Screening Demonstration Project. No screening is offered in Québec outside of this project.
Institutions offering lung cancer screening:
- Centre universitaire de santé McGill (CUSM Centre hospitalier de l’Université de Montréal (CHUM)
- Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval (IUCPQ - UL)
- Centre intégré universitaire de santé et de services sociaux de l’Estrie - (CHUS)
- Centre intégré de santé et de services sociaux de Laval
- Centre intégré de santé et de services sociaux de la Côte-Nord
- Centre intégré de santé et de services sociaux de la Montérégie-Centre.
All participating screening centres providing scans to eligible individuals have been designated by the Ministère de la Santé et des Services sociaux (MSSS).
Eligible individuals may participate in the project at one of the centres regardless of where they live.
In addition to the screening CT scan, these facilities also offer complementary tests, such as supplemental scans and magnetic resonance imaging.
Only institutions designated by the MSSS can offer screening CT scans under the project. To be designated, these hospital centres are subject to rigorous quality standards set by the MSSS.
All professionals who work in these centres have the qualifications required by their professional corporation. In Québec, professional corporations ensure the quality of their members’ professional acts.
Specialized services where further examinations are required
When there is a suspicion of cancer following an abnormal CT scan, the project’s coordination centre refers participants to specialized services to verify the presence or absence of cancer by means of additional examinations.
As with the screening CT scans, the further tests must meet rigorous quality standards.
The MSSS, the Institut national de santé publique du Québec (INSPQ) and the Institut national d’excellence en santé et en services sociaux (INESSS) are cooperating on the evaluation of the project. The INSPQ and the INESSS are mandated to measure the results and performance of the project, while the role of the MSSS is to assess its implementation.