Dr. Heidi Schmidt, Program Medical Director and Department Head of the Joint Department of Medical Imaging, is a dedicated leader in the fight against lung cancer. (Photo: UHN)

Lung cancer is the leading cause of cancer death in Ontario. A one-minute scan can detect the disease in its earliest stages.

The Ontario Lung Screening Program (OLSP) at UHN detects an average of nearly one new case of lung cancer every week. This detection rate highlights the evolution of the OLSP from pioneering research to a vital clinical practice.

Lung cancer screening with low-dose computed tomography (LDCT) has a long history spanning two decades, from infancy as an early research study to a fully operational program.

Dr. Heidi Schmidt, Program Medical Director and Department Head of the Joint Department of Medical Imaging (UHN, Sinai Health, Women's College Hospital), was one of the earliest driving forces behind the program's remarkable success and expansion.

"I am proud that our work in the early 2000s has translated into a successful program, saving lives of many individuals at risk," says Dr. Schmidt.

Back in 2002, when Dr. Schmidt first became involved in lung cancer screening, the use of LDCT to detect lung cancer was just an idea explored in a few research studies in the United States. That year, under the leadership of Dr. Frances Shepherd, The Princess Margaret Cancer Foundation received a donation to support the early detection of lung cancer.

Over the subsequent decade, the lung cancer screening program evolved into the largest research study of its kind at Princess Margaret Cancer Centre, with an impressive 4,782 participants by 2009. However, its own success posed challenges, as the influx of participants each year strained resources.  

"We needed a lot of timeslots, so we took advantage of cancelled appointments and scanned on weekends," says Dr. Schmidt.

The study concluded in 2009.

"We felt safe closing the study because there was a lot of literature indicating that sooner rather than later, lung cancer screening would become a clinical tool," says Dr. Schmidt.

In June 2017, Cancer Care Ontario, now part of Ontario Health, initiated the Ontario Lung Cancer Screening Pilot for People at High Risk, making it the largest of its kind in Canada.

The Lung Cancer Screening Team supports participants throughout the screening process. Members of the team include, (L to R), Adam Koskie, patient navigator; Dr. Micheal McInnis, thoracic radiologist; and Nya Mitchell, appointment scheduler. (Photo: UHN)

Participants underwent a low-dose CT scan – a quick, painless and non-invasive approach that uses minimal radiation and takes less than one minute to complete. The scan provides detailed images of the lungs.

Between 2017 and 2021, the pilot project recruited more than 13,000 individuals across its four participating locations: UHN, The Ottawa Hospital, Health Sciences North, and Lakeridge Health. In 2021, the pilot became a program.

Dr. Schmidt, who served as the Radiology Lead at Cancer Care Ontario from 2017 to 2023, played a pivotal role in ensuring quality control, low-dose protocols, radiologist training and reporting templates. "Lung screening is an amazing tool, but it's important to get the right people into the program and make sure there's a proper risk assessment," says Dr. Schmidt.

This is where appointment scheduler Nya Mitchell and patient navigators, Adam Koskie and Anna Roy, step in with their pivotal contributions. They work closely with patients, guiding them through risk assessments, booking appointments, communicating results and offering smoking cessation support.

"The navigators for the lung cancer screening program make it very easy for our referrers," says Dr. Micheal McInnis, thoracic radiologist in the Joint Department of Medical Imaging at UHN and a leader for OLSP at UHN since 2017. "It creates a seamless experience for participants and ensures we're operating in a uniform way."

The success of OLSP is underlined by its expansion, with recent growth extending from Toronto General Hospital to Women's College Hospital, increasing capacity by 50 per cent. This translates to screening 50 participants a week.

"Now we are really seeing an impact because we're screening the right people more efficiently and detecting cancer earlier," says Dr. McInnis.

Dr. McInnis is one of eight specialized thoracic radiologists who read scans for OLSP at UHN. The team hopes the program will continue to expand, ensuring more Ontarians receive the lifesaving benefits of early lung cancer detection.

"It's been truly remarkable to watch this program expand," says Dr. Schmidt. "Early detection is the key to our battle against lung cancer, a disease often concealed in asymptomatic silence until it reaches advanced stages.

"With over two decades of specialization in this field, we have the knowledge to identify those at risk, treat patients sooner and provide improved outcomes."

Ontario's Lung Screening Program eligibility includes being 55 to 74 years old, and having smoked cigarettes daily for at least 20 years, though not necessarily consecutively. Participants can refer themselves or ask a doctor to refer them to the program. Learn more at uhn.ca/lungscreening 

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