Advancing equity in lung cancer diagnosis

Lung cancer in Canada

In Canada, there were an estimated 32,900 new diagnoses of lung cancer in 2025;¹  it is the leading cause of cancer-related deaths.²

Healthcare in Canada is delivered provincially, and three provinces have organised screening programmes for lung cancer: Ontario, British Columbia and Nova Scotia.^{3 4} Other provinces are at different stages of launching pilots or implementing organised screening programmes.³
 

Implementing Ontario’s screening programme

In 2017, Ontario initiated a pilot study to inform the potential implementation of a low-dose computed tomography (LDCT) screening programme.⁵ The pilot yielded promising results: 28 people were diagnosed with lung cancer, of whom 20 (71.4%) were diagnosed at an early stage (stage I or II).⁵

Following the pilot’s success, the Ontario Lung Screening Program (OLSP) was established in 2021.^{3 6}

OLSP sites use a validated risk calculator to determine eligibility.^{3 6} They provide smoking-cessation support, conduct baseline LDCT scans and coordinate annual screening.³ These sites also facilitate seamless onward referral – communicating screening results, incidental findings and next steps to referring providers, family physicians and nurse practitioners.³
 

Eligibility criteria and the personalised risk score

The OLSP uses a two-step recruitment process to identify who has a high risk of developing lung cancer and is eligible for screening.⁶

First, a healthcare provider refers a person to the programme. Or people can self-refer, provided they:^{3 6}

• are aged 55–80
• have smoked (any number of) cigarettes daily for 20 years
• have Ontario Health Insurance Plan coverage.

Next, a screening navigator conducts a formal risk assessment based on medical and smoking history.^{3 6} The navigator calculates a personalised risk score, which estimates the likelihood of someone developing lung cancer within the next six years.^{6 7} People who are eligible for screening must have a 2% or higher likelihood of developing lung cancer in the next six years.⁶

From 2017 to 2021, 6,785 people underwent LDCT screening and invasive lung cancer was detected in 76 of them.⁸
 

Addressing inequities

The OLSP addresses health inequities by targeting people who are historically underserved or disproportionately affected by lung cancer, including people of low socioeconomic position, people in rural and remote areas, and other communities with limited access to healthcare.⁹ Several of the programme’s initiatives address these health inequities:

• The sites operate a hub‑and‑spoke model, enabling people to be screened closer to home.¹⁰
• The sites take responsibility for local recruitment and have tailored approaches to engage underserved populations in their regions.¹⁰ Common approaches for recruitment include targeted community outreach in partnership with primary care; community health centres; Indigenous health organisations; local public health units; and a focus on neighbourhoods with higher smoking prevalence and lower screening participation.³
• Patient navigation is also a core component of the screening pathway, supporting communication and reducing barriers to care through non‑judgemental, person‑centred guidance.³ Navigators receive training in culturally sensitive, trauma‑informed and inclusive communication, in alignment with local equity priorities.³
• As First Nations, Inuit and Métis populations remain under‑represented in screening programmes for lung cancer, an initiative was set up to examine systemic barriers affecting Inuit peoples along the care pathway and impeding participation in lung cancer screening. Findings will inform an appropriate, culturally relevant screening model.⁸

The future of the OLSP

Canada’s 2026–2035 Pan-Canadian Lung Cancer Action Plan aims to reduce lung cancer mortality by 30% by 2035.¹¹ The plan is a collaborative initiative led by clinicians, patient advocacy organisations, charities, researchers and people with lived experience to advance action on lung cancer across Canada.¹² While not a government or regulatory body, the initiative advocates for the expansion of lung cancer screening across Canada.¹²

In alignment with broader national goals to improve early detection, the OLSP is planning to expand to every region in the province by spring 2026.^{12 13}

The OLSP shows that a person-centred, equitable approach helps screening programmes detect lung cancer sooner. Its strong focus on equity and targeted outreach offers a valuable model for other countries developing screening programmes.