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Guidelines & Advice
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Ontario Lung Screening Program Referral Form and Eligibility

This page tells healthcare providers how to refer patients at high risk of getting lung cancer to an Ontario Lung Screening Program location to determine if they are eligible for screening.

Referral Form – Ontario Lung Screening Program
Discuss potential benefits and potential harms of lung screening with the patient before you refer them.

Referral Criteria

If you are referring someone age 55 to 80, they must:

  • have a smoking history of any amount of cigarettes daily for 20 years
  • have Ontario Health Insurance Plan (OHIP) coverage

If you are referring someone age 81 or older, they must:

  • have a smoking history of any amount of cigarettes daily for 20 years
  • have Ontario Health Insurance Plan (OHIP) coverage
  • have discussed risk and benefits of lung screening with you
  • be well enough to undergo and recover from lung cancer treatment
  • have a lifespan (over 5 years) to benefit from treatment

A referral is required from a healthcare provider for each routine low-dose CT scan (every year) for people over age 80.

Who is Not Eligible

Not everyone who meets the referral criteria will be eligible for lung cancer screening in the program.

Someone is not eligible to participate in the Ontario Lung Screening Program if they:

  • have been diagnosed with lung cancer
  • are actively under surveillance for lung nodules
  • have had hemoptysis of unknown cause or unexplained weight loss of more than 5 kilograms (11 pounds) in the past year
  • are undergoing diagnostic assessment, treatment or surveillance for life-threatening conditions (such as a cancer with a poor prognosis)

Screening is not appropriate for people with suspected lung cancer. If someone has the following lung cancer symptoms, follow the Program in Evidence-Based Care guidelines for referral of suspected lung cancer and our lung cancer diagnosis pathway:

  • Hemoptysis (single episode)
  • New finger clubbing
  • Suspicious lymphadenopathy (such as cervical, supraclavicular)
  • Dysphagia
  • Features of metastatic lung cancer (such as weight loss over 5 kilograms, focal skeletal pain, headaches)
  • Features suggestive of paraneoplastic syndromes

Determining Eligibility Is a 2-Step Process

Only people with Ontario Health Insurance Program (OHIP) coverage who meet the criteria in steps 1 and 2 will be eligible to get screened for lung cancer through the program.

  • Step 1: Healthcare providers refer patients who meet the referral criteria to an Ontario Lung Screening Program (OLSP) location. An OLSP referral form must be completed to authorize the use of low-dose computed tomography if the patient is found to be eligible in step 2.

    People can also contact an OLSP location on their own to have their referral criteria assessed.
  • Step 2: An OLSP location conducts a risk assessment with anyone who meets the referral criteria in step 1. The results of the risk assessment in step 2 determine whether someone is eligible to get screened for lung cancer through the program.

    People who contact an OLSP location directly and are found to be eligible in step 2 will still need a referral from a healthcare provider to participate in lung cancer screening through the program. The OLSP location will work with the person to contact their provider and request a referral.

The risk assessment is done using a risk calculator, which is based on a statistical risk prediction model that gives an estimate of someone’s risk (as a percentage) of developing lung cancer in the next 6 years.[1] The risk assessment considers factors such as[1]:

  • age
  • cigarette smoking history
  • body mass index
  • education
  • personal history of cancer and chronic obstructive pulmonary disease
  • family history of lung cancer

People with a 2% or greater risk of developing lung cancer over the next 6 years are considered eligible to participate in the Ontario Lung Screening Program.

To find or contact participating locations, see Ontario Lung Screening Program Locations.

For details about the program, see Ontario Lung Screening Program.

Reference

  1. Tammemagi MC, Katki HA, Hocking WG, Church TR, Caporaso N, Kvale PA, et al. Selection criteria for lung-cancer screening. N Engl J Med. 2013 Feb;368(8):728–36.