Lung cancer and equity report

Detecting and treating lung cancer

People whose lung cancer is detected early have a better chance of recovering than people who are diagnosed later. However, in Canada, people with lung cancer are more likely to be diagnosed at an advanced stage (stage III or IV) than people diagnosed with breast, prostate or colorectal cancer.

Lung cancers are more commonly diagnosed at stage III or IV than colorectal, prostate, or breast cancers.

Data source: Statistics Canada, Canadian Cancer Registry (2012–2016)

Lung cancer may cause few symptoms for months or even years. Screening people who are at high risk (e.g. based on factors such as age and smoking history) can help ensure the disease is caught in the early stages, before symptoms arise, and when chances of cure and survival are higher.

Organized, jurisdiction-wide lung cancer screening programs are not yet available in Canada.

When symptoms do arise, they can be general, making early detection and diagnosis challenging. There are also barriers to early presentation and diagnosis of lung cancer, which are often complex and multifaceted.

What does the inequity look like?

Stage at diagnosis

People with lung cancer are more likely to be diagnosed with advanced disease if they have lower income.

Surviving cancer is strongly associated with the stage at which the disease is diagnosed. Unfortunately, research suggests that people with lower incomes are less likely to have their symptoms recognized and investigated early, resulting in a more advanced stage of cancer at diagnosis.

This income-based disparity is largely due to factors outside an individual’s control. For example, people with lower income may live and work in environments that increase their risk of cancer, and face barriers to accessing cancer screening, diagnosis and high-quality treatment (e.g. difficulty making appointments, less secure or flexible employment, poor experience with health care providers).

People with lung cancer are more likely to be diagnosed with advanced disease if they have lower income.
Data source: Statistics Canada, Canadian Cancer Registry (2013-2015) linked with T1 Family File

There is no difference in the proportion of advanced lung cancer diagnosis for people living in urban or rural communities: for both, it is 70 percent. Although this finding is positive, rural and remote communities face numerous social and economic challenges that make it more difficult to access cancer diagnostic and treatment services.

Access to treatment

Early detection gives people more treatment options, including the most effective treatment: surgery to remove the tumour. Surgical removal is the mainstay of treatment at stages I and II of lung cancer, as it increases the chances of survival and can be curative.

People diagnosed with stage I or II non-small cell lung cancer, and who are at the highest income level, are more likely to receive curative surgery than patients in the lowest income level.

Income can contribute to challenges accessing treatment and care. For example:

People diagnosed with stage I or II non-small cell lung cancer, and who are at the highest income level, are more likely to receive curative surgery than patients in the lowest income level.
Data source: Canadian Cancer Registry (2012-2014) linked with T1 Family File and Discharge Abstract Database

  • People with lower income may face more barriers to surgery as a result of less secure or flexible employment. They might not be able to take time off work, pay for travel to a treatment centre or cover out-of-pocket treatment costs.
  • Comorbidity is common among people with cancer, but consensus is limited on how to manage cancer and comorbid conditions. Evidence suggests that some cancer patients with comorbidity may have their treatment unnecessarily modified, which can compromise optimal care. People with lower income have a higher prevalence of comorbidities than those with higher income. Therefore, they may be less likely to receive curative treatment.
  • A small proportion of patients may decline recommended treatment. Although reasons have not been well researched, certain supports may help manage patients’ uncertainty around health outcomes and better assist them in making an informed choice. These supports include the quality of information provided to patients on what to expect in relation to treatment, and having a trusting and established relationship between physician and patient.

People living in rural and urban areas have similar rates of curative surgery when diagnosed with stage I or II non-small cell lung cancer.

While the proportions may be similar, the cancer experiences of individuals living in rural and urban areas may differ considerably. Numerous barriers make the experience of living with lung cancer and accessing care more complex for individuals living in rural areas.

People living in rural and urban areas have similar rates of curative surgery when diagnosed with stage I or II non-small cell lung cancer.
Data source: Canadian Cancer Registry (2012-2014) linked with T1 Family File and Discharge Abstract Database

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