Risk-based lung cancer screening performance in a universal healthcare setting

Previous trials demonstrated that low-dose computed tomography lung cancer screening of high-risk individuals can reduce lung cancer mortality by at least 20%. Outside the United States, adoption of lunc cancer screening has been slow. The Ontario Lung Cancer Screening Pilot succesfully recruited 7,768 individuals at high risk identified by using the PLCOm2012noRace lung cancer risk prediction model. In total, 4,451 participants were successfully screened, retained, and provided with high-quality follow-up. The lung cancer detection rate and the proportion of early-stage cancers was 2.4% and 79.2%, respectively; serious harms were infrequent; sensitivity to detect lung cancers was at least 95.3%; specificity was 95.5%; and adherence to annual recall and early surveillance was at least 85%. The authors conclude that the Ontario Lung Cancer Screening Pilot provides insights into how a risk-based organized lung screening program can be implemented in a large, diverse, populous geographic area within a universal healthcare system.