Lung Cancer Physician Risk Assessment Download

The risk of lung cancer is considered high (≥1.5%) and they may be eligible for lung cancer screening.

Please fax the completed referral form to the Alberta Lung Cancer Screening Program 1-888-944-3388.

Click to complete a new form

This version of the PLCOm2012 model with race in 3 categories has been validated in PLCO intervention arm smokers, NLST data and CREST data. References include:

Tammemagi M, Hormuzd K, Hocking W, et al. Selection Criteria for Lung-Cancer Screening. New England Journal of Medicine. 2013;368(8):728-36. doi: 10.1056/NEJMoa1211776.

Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. The New England journal of medicine. 2011;365(5):395-409. Epub 2011/07/01. doi: 10.1056/NEJMoa1102873. PubMed PMID: 21714641.

Pasquinelli MM, Tammemagi CM, Kovitz KL, et al. Risk Prediction Model versus United States Preventive Services Task Force Lung Cancer Screening Eligibility Criteria – Reducing Race Disparities. Journal Thoracic Oncology. 2020; Released 18 August 2020.