Albertans ages 50 to 74 who currently smoke cigarettes or quit after smoking for many years — the group most at risk of developing lung cancer — can now take the online lung cancer risk self-assessment. If you have questions about your eligibility for lung cancer screening contact Alberta Lung Cancer Screening Program (ALCSP) at 1-866-727-3926 option 4 or you can contact your primary care provider for a referral. 

Getting screening is one of the best ways to find lung cancer early, before you have symptoms, and when treatment is more likely to work.

Currently, 7 out of 10 lung cancer cases are found when the cancer is in the late stages (advanced) and is much harder to treat or cure. This means the cancer has already spread to other body parts, or there is too much cancer in the lung(s). Early lung cancer does not cause symptoms, which is why it is often not caught early. That is why screening when you are at high risk is important. Regular screening can lower your risk of dying from lung cancer by almost 25%.

While some think screening is stressful, some are happy that screening is available. Everyone has different thoughts and feelings—there is no right or wrong way to feel. Talking to your health care provider, a trusted family member, or a friend can help you decide on screening.

Lung cancer screening is for Albertans who are at a high risk for lung cancer. You may be eligible for lung cancer screening if you:

•  Are 50 to 74 years of age, AND
•  Are someone who smokes cigarettes or quit smoking after smoking for many years. For example, you smoked 1 pack per day for at least 15 years, or less than 1 pack per day but for more than 15 years, AND
• Have a family physician or other primary care provider, such as a nurse practitioner. (Albertans who do not currently have a family doctor can visit albertafindadoctor.ca to help find one.)

You may not be eligible for lung cancer screening based on your age, smoking history, or other active respiratory diseases. Please check with your primary care provider.

Many different factors make up your overall lung cancer risk, including a family history of lung cancer, personal history of other types of cancer and other lung conditions, how many years you smoked for, how many cigarettes per day, as well as your weight to height ratio. Lung screening for someone with a low risk of lung cancer may not benefit them as it is less likely that a scan would find any signs of cancer, and the scan itself could cause unneeded stress and unnecessary radiation exposure. There can also be false positive results, leading to anxiety and unnecessary procedures like a biopsy. A false positive test result is an error in the test result when it says that someone has a cancer when the person does not. This leads to unnecessary tests or surgeries that are not of benefit, causing more harm than good.

Lung cancer risk increases with age and is much less common before the age of 50. We have no evidence at this point that screening is effective in younger patients. In addition, the risks associated with radiation from the CT scan is higher for younger people. Because of this, the program does not offer screening for people less than 50 years of age. If you have other risk for lung cancer, consider contacting the program again when you reach age 50. Most other Canadian screening programs do not start until age 55.

Even though lung cancer risk goes up with age, the main research studies which have demonstrated the effectiveness of lung cancer screening did not include people older than age 74. Since early detection of lung cancer aims to prevent a more advanced diagnosis several years later, the benefit of screening decreases as we get older and develop other health problems. Older people may also be more likely to have complications resulting from the screening findings. Because of this, the screening program does not offer screening after age 74 which is in line with other Canadian programs.

Smoking is not the only risk factor for lung cancer —radon gas, asbestos, genetics and outdoor air pollution are also important risks. However, this pilot program is only for screening people who currently or previously smoked cigarettes. Cigarette smoking is the cause of 8 out of 10 cases of lung cancer. People who have smoked for many years are at the greatest risk, and our risk models incorporate several other components such as family history of lung cancer. While people who have never smoked cigarettes can still get lung cancer, this is much less common so that a very large number of people would have to get screened to find these rare cancers. Research to date has not been able to identify people who have not smoked but have high enough risk of lung cancer to justify screening. Research is underway, including here in Alberta, to help us better identify individuals with no or minimal smoking who may still be at risk of lung cancer so that they can get screened as well. Unfortunately, at this point in time our available tools are not precise enough to allow screening outside of the criteria established.

People who are at high risk of getting lung cancer and are eligible to get screened will be offered a low-dose computed tomography (CT) scan that uses a small amount of radiation. The low-dose CT scan uses x-rays to take detailed pictures of your lungs. It can find changes in your lungs before you have any symptoms. The procedure is quick and non-invasive. Lung cancer screening is safe and effective.

The low-dose CT scan will be performed in a hospital. During the scan, you will lay still on a table, while the machine takes detailed images of your lungs. There is no prep needed for this test. The scan takes less than 15 seconds and is not painful. You can stay in your own clothes.

The technologist doing your scan will guide you through the process. If you have any issues with claustrophobia (fear of confined spaces), tell your technologist so they’re aware and can help you. You can return to your usual activities immediately after a low-dose CT scan.

As with any medical procedure, there are both benefits and risks.

Benefits

• Screening can find some cancers early when treatment may be more likely to cure the cancer.
• If found early enough, the cancer can be removed by surgery or treated with radiotherapy (using radiation to kill cancer cells).
• It lowers the chance of dying of lung cancer.

Risks

• Screening for lung cancer uses a low dose of radiation. There is a risk of damage to cells or tissue from exposure to radiation, including the small amounts used in low-dose CT scans, X-rays, and other medical tests. The risk of radiation causing another type of cancer is extremely low.
• Low-dose CT scans are imperfect and may miss very small cancers hidden behind structures in your chest.
• Some lung cancers can grow very fast, and you may develop lung cancer between your annual exams.
• You may find lung cancer screening stressful because it may find abnormalities or cancer you were unaware of.

You may experience these benefits or risks differently than others. First, decide for yourself if the benefits are worth more than the risks. Then, discuss the options with your primary care provider and family to help you decide if screening is right for you.

Eligible Albertans can take the online lung cancer risk self-assessment or be referred to the program by a primary care provider. Take the online assessment, speak to your primary care provider or call the Alberta Lung Cancer Screening Program (ALCSP) at 1-866-727-3926 option 4 to see if you’re eligible to participate in lung cancer screening.

An ALCSP registered nurse or nurse practitioner will review the risks and walk the patient through the next steps in the screening process, which may include a low-dose CT scan at one of the following diagnostic imaging centres.

Patients who meet all eligibility criteria can choose to travel to a designated diagnostic imaging centre if they wish to participate.

If you do not have a family doctor, please click on one of the PCNs above or visit www.albertafindadoctor.ca to help you find a doctor accepting patients in your area.