Lung cancer screening in Quebec - implementation using a web based platform


Implementation of Lung Cancer (LC) screening in heavy smokers using annual low dose CT scans (LDCT) has been shown to allow for LC to be diagnosed earlier. One of the main challenges is identifying individuals at the highest risk of LC. Moreover, false positive findings are frequent, and may result in unnecessary consultations and investigations. We propose to implement a web-based LC screening program in Quebec. Patients referred to the program will be triaged according to the INESSS recommendations on LC screening eligibilty. The eligibility questionnaire will be made accessible through a mobile application called Opal developed at the RI-MUHC ( If a patient is deemed eligible, they have a formalized shared decision making encounter. They will also have access to services such as smoking cessation and educational material about lung cancer screening such as risk and benefits. In addition, patients will receive the results of their scan in custom written and curated personalized letters. Following the LDCT, intelligent reports will be generated by the softworks platform. These reports will provide evidence-based guideline recommendations of follow up intervals for repeat CT and management of incidental findings identified on the CT scan. By implementing this reporting mechanism, we will ensure patients do not receive inappropriate tests after their LDCT scan. By targeting screening those at highest risk of lung cancer, the program will help avoid unnecessary follow-up procedures, which place a large burden on tertiary care services and specialist practices. In addition, it will ensure the lowest budget impact in a single payer healthcare system, thereby improving organizational efficiency and appropriate use of tertiary care services.