I have been diagnosed with lung cancer three times. After the first, an acquaintance asked the question that patients with lung cancer always get, yet patients with breast cancer never do: “Did you smoke?” Then she added, “You don’t look like a smoker.” As if my cancer owed her an explanation. As if a yes would have made it my fault—and me less worthy of care.

The World Health Organization’s (WHO’s) International Agency for Research on Cancer (IARC) recently concluded that low-dose CT (LDCT) screening of people at high risk reduces both lung cancer-related deaths and the incidence of late-stage disease.1 For countries still dragging their feet on lung cancer screening programs, the last scientific arguments for delay are gone. 

The announcement raises an uncomfortable question: Why has this taken so long to implement screening programs? The evidence did not suddenly appear in 2026.

During the past two decades, three landmark studies involving tens of thousands of participants—I-ELCAP, NLST, and NELSON—have demonstrated the power of LDCT to find lung cancer early and reduce mortality.2,3,4

For years, the medical establishment challenged the evidence, citing concerns about false positives, radiation, and study design. The IARC conclusion puts those questions to rest. Early detection screening saves lives.

Canada acted on mammography within three years of promising trials being completed in Sweden5—and continued rolling out programs nationally while Canada’s own randomized trial6 was publishing “no benefit.” The evidence was contested, the harms debate raged for decades, and nobody waited for a WHO agency to settle it.

When the medical community contested the evidence—and the patients were women with breasts—Canada built a national screening system within a decade. When the patients were people with lungs who smoked, Canada hedged.

We cannot separate that delay from the spoken and unspoken stigma attached to lung cancer. And the delay has had consequences.

Ten years ago, my first cancer was discovered by accident, during testing for something else. I was lucky. It was found at stage I and treated with surgery. By my calculation, had a national program begun within a decade of the NLST results, thousands of Canadians’ lives could have been saved.7

The consequences are not only measured in lives. They are measured in dollars. LDCT shifts diagnosis to earlier-stage disease, when lung cancer is easier and far less expensive to treat.8 A 2025 study found that treating stage I lung cancer costs an average of $15,365 compared with $140,594 for first-line stage IV treatment alone. Then consider the costs of second-line treatments, hospitalizations, and palliative care.9

And none of those metrics can measure the emotional cost of a stage IV diagnosis. Nor can they begin to measure the collateral damage done to patients with lung cancer with no smoking history. Nearly 30% of lung cancer diagnoses in British Columbia occur in people who have never smoked.10 The lack of screening programs and focus on smoking history misses many people at risk, including those without a smoking history but with other potential lung cancer risk factors. I have already lost two young friends to stage IV lung cancer this year.

Fifteen years after the landmark NLST results, Canadians still do not have consistent access to organized lung cancer screening. Depending on where they live, screening may be established, piloted, planned, or unavailable altogether. Survival should not depend on a postal code. 

The federal government and the provinces should use the Pan-Canadian National Lung Cancer Action Plan11 to establish national standards and ensure equitable access to organized lung cancer screening throughout the country. The IARC report must be the starting gun—not another consultation.

The provinces sued Big Tobacco for the healthcare costs of smoking and will receive $24.7 billion under the resulting settlement.12 They should spend at least a small portion of it finding lung cancer early. A national screening program would cost a rounding error of the award.

I was lucky.

In Canada, luck shouldn’t be the lung-cancer screening program. No victim of the tobacco industry’s deception should have to apologize to earn a CT scan.

References

• 1. Neamtiu L, Callister MEJ, Crosbie P, et al. IARC Perspective on Lung Cancer Screening. N Engl J Med. 2026;395(15):1545-1552. doi:10.1056/NEJMsb2608211
• 2. International Early Lung Cancer Action Program
• 3. National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395-409. doi:10.1056/NEJMoa1102873
• 4. de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial. N Engl J Med. 2020;382(6):503-513. doi:10.1056/NEJMoa1911793
• 5. Tabár L, Fagerberg CJ, Gad A, et al. Reduction in mortality from breast cancer after mass screening with mammography. Randomised trial from the Breast Cancer Screening Working Group of the Swedish National Board of Health and Welfare. Lancet. 1985;1(8433):829-832. doi:10.1016/s0140-6736(85)92204-4
• 6. Miller AB, To T, Baines CJ, Wall C. The Canadian National Breast Screening Study: update on breast cancer mortality. J Natl Cancer Inst Monogr. 1997;(22):37-41. doi:10.1093/jncimono/1997.22.37
• 7. Author’s calculation: NLST’s 20% mortality reduction applied to Canadian Cancer Statistics 2025 projected lung cancer deaths (19,400/yr), with 26.7% of lung cancers meeting NLST eligibility (Pinsky & Berg, J Med Screen 2012), across uptake scenarios of 30–70% — yielding roughly 3,100–7,300 preventable deaths over ten years.
• 8. Lung Cancer Policy Network. The screening program for lung cancer in the Canadian province of British Columbia. (May 2022–Dec 2023: Detection rate 16.3 per 1,000; 75% of screen-detected cancers at stage I or II).
• 9. Griffin D, MacDonald I, Danforth J P3.01.24 Economic Burden of Radon Attributable Non-Small Cell Lung Cancer: A Cost Analysis. J Thorac Oncol, 20S412
• 10. Lung Cancer Policy Network. The screening program for lung cancer in the Canadian province of British Columbia.
• 11. Canadian Cancer Society, 2026–2035 Pan-Canadian Lung Cancer Action Plan.
• 12. Compensation Plans Approved by the Ontario Superior Court, Mar. 6, 2025; $24.725B to provinces/territories. Tobacco Claims Canada.