Background: In September 2022, the Alberta Lung Cancer Screening Program (ALCSP) launched a two-year pilot program to screen 3,000 high-risk individuals for lung cancer using low-dose computed tomography (LDCT) in Alberta, Canada.

Objectives: To evaluate and report the quality indicators and health outcomes for the first 3,000 participants in the ALCSP after a minimum of one year of follow-up. Quality indicators were guided by the International Association for the Study of Lung Cancer recommendations.

Methods: Participants were referred to the ALCSP either by self-referral or by their primary care providers (PCP) using a faxed referral form or a web-based risk assessment tool that collected demographic and lifestyle factors. Eligibility for screening was based on age (50 to 74 years) and a six-year lung cancer risk estimate of 1.5% or greater using the PLCOm2012 3-race model. All those currently smoking were referred to smoking cessation supports regardless of program eligibility or enrollment. Eligible individuals received a baseline LDCT, with follow-up intervals and nodule management guided by the Lung CT Screening Reporting and Data System (Lung-RADS) v2022. Exams were interpreted by subspecialty trained chest radiologists. Participants with findings suspicious for lung cancer were referred to the Alberta Thoracic Oncology Program for diagnostic workup. Data were extracted from electronic medical records, presented as N (%), mean (SD), and median (IQR).

Results: By August 2024, 5,638 Albertans were referred and assessed for ALCSP eligibility; 3,841 individuals (68.1%) met the eligibility criteria and 3,427 (89.2%) completed a baseline LDCT. Among the first 3,000 ALCSP participants, the mean age was 64.2 years (SD=5.4), 44.3% were female, and had a self-reported racial distribution of 0.7% Black, 5.1% Indigenous, and 94.2% other (primarily white). Most participants were currently smoking (75%) with an average of 21.1 (SD=8.5) cigarettes per day for 43.3 years (SD=8.4). The average PLCOm2012 six-year lung cancer risk was 4.7% (SD=3.8). The median time to baseline LDCT scan was 34 days (IQR=24 to 57). The first 3,000 ALCSP participants completed 6,073 LDCT exams (3,000 baseline and 3,073 subsequent exams). Baseline LDCT had the following Lung-RADS distribution: 0: 5 (0.2%), 1 & 2: 2,679 (89.3%), 3: 140 (4.7%), 4A: 113 (3.8%), 4B: 27 (0.9%), and 4X: 36 (1.2%). Baseline LDCT follow-up rates within recommended intervals were: 77.0% for Lung-RADS 1 or 2 (annual), 82.9% for Lung-RADS 3 (within 6 ± 2 months), and 84.1% for Lung-RADS 4A (within 3 months ± 6 weeks). Following baseline LDCT, there were 40 lung cancers detected (13.3 per 1,000 screens) with 31 stage I or II, 4 stage III, and 5 limited or extensive stage SCLC. Nineteen post-baseline cancers (3.7 per 1,000 screens) have been detected so far, with 79% early-stage diagnoses. Ninety-seven percent of early-stage lung cancers received treatment with curative intent. Only 1.2% of LDCT were considered false positives, where a referral for diagnostic workup did not lead to a lung cancer within 12 months.

Conclusions: The pilot ALCSP demonstrated feasibility with high participation and follow-up rates, strongly supporting its expansion to a full-scale provincial lung cancer screening program.