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Clinical and Implementation Research

Project Co-Leads: Drs. Heidi Schmidt and Geoffrey Liu

Vision: Data from our unique group of screening participants will improve who, how and when patients are screened for lung cancer using low-dose CT scans.

Main Hypothesis: 

Current screening methods use guidelines to decide who does and does not get screened for lung cancer. These programs, however, have reported inefficiencies, since the screening algorithms used to select patients have yet to be optimized. This means that some patients who are ineligible for screening will develop lung cancer, while the majority of individuals who undergo screening will not. This an ineffective screening method that needs to change. 


The Toronto I-ELCAP program recruited study participants from the University of Toronto. These participants are uniquely different from those in other screening studies. This study included younger individuals who smoked less (i.e. not traditionally at higher risk), in addition to the usual older, heavy-smoking population. This study also screened patients for a variety of time periods in between scans, from as short as one year to as long as seven years. The lung function of some patients was also evaluated. 


This impressive repository of information allows us to now explore which patients should be screened and how often. These refined guidelines will not only render lung cancer screening more cost-effective, but also reduce false positive results, which lead to patient anxiety and potentially invasive treatments like surgery. 


We will be following up with more than 4,000 individuals to determine if they have lung cancer, and at the same time, arranging for re-screening to generate more data. An important piece of this process is that our data will be linked with Ontario-wide databases to obtain death and cancer data. We will also investigate how screening programs can be made more accessible to low-income individuals. This demographic tends to smoke more cigarettes more frequently, and often without access to good healthcare. Inner-city immigrants, for instance, can be particularly at-risk because of language and cultural barriers. 


What will the impact be five years from now?

Improving screening efforts will help make lung cancer research more impactful, reaching those most in need, while reducing deaths and healthcare costs. With more efficient screening programs, more individuals at risk of developing lung cancer–such as people who have never smoked–can be reached. 

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