Editors’ note: This article is written by Jane Pezarro, with input from Dr. Christian Finley.
Every Wednesday in December, the floor of Christian Finley’s lung cancer clinic disappears, buried under gift bags and boxes. Chocolate. Christmas cards. Tokens of gratitude stacked so thick he can barely see the tiles. Fifteen years ago, that floor would have been bare.
“The vast majority of the cancer patients I see now are cured,” Finley, thoracic surgeon at St. Joseph’s Healthcare Hamilton, tells me. “That simply wasn’t true for my father or my grandfather.”
Finley is a third-generation thoracic surgeon, highly skilled in minimally invasive surgery and one of Canada’s leading advocates for lung cancer screening. He describes surgical procedures from his grandfather’s era, performed with what he calls “prehistoric” instruments. Operations were large, brutal and slow to heal. Today, more than 90 per cent of his surgeries are done through tiny incisions. Most patients go home the next day. Screen-detected tumours often are so small that only a sliver of lung tissue is removed.
What changed was not the disease. It was the timing of the discovery of the disease.
Lung cancer is treacherous because the lungs have no pain receptors. Early-stage disease rarely causes symptoms. By the time a persistent cough, chest pain or unexplained weight loss appears, the cancer has often spread. Stage IV lung cancer still carries a devastating prognosis.
But early-stage lung cancer is a different disease altogether.
“When we find it early, it’s highly curable,” Finley says. “Stage I survival is now around 80 per cent. In some Japanese studies, it’s even higher.”
For more than a decade, large international studies have shown that lung cancer screening reduces mortality by about 20 per cent in people who are at high risk. In medicine, that is an extraordinary outcome. If a drug reduced deaths from heart attacks or childhood illness by that margin, it would be adopted almost overnight.
“That we’re not screening everywhere,” Finley states, “is a travesty.”
Screening was proven in 2011. In 2026, it remains unavailable to most Canadians. British Columbia, Ontario and Nova Scotia offer it province-wide. Elsewhere, Alberta, Quebec and Newfoundland and Labrador are running pilot programs. Saskatchewan, Manitoba and New Brunswick are in the planning stages. As of this writing, there are no programs planned or underway in Prince Edward Island, Northwest Territories, Nunavut or Yukon.
This is not because the science is uncertain, the technology unproven or the costs prohibitive. Lung cancer screening is cost-effective, comparable to breast and colorectal cancer screening, both of which are universally available. Economists measure cost-effectiveness using the incremental cost-effectiveness ratio, a standard metric that weighs cost against years of healthy life (i.e., quality life adjusted years) gained. Lung cancer screening falls well within accepted thresholds.
“It gets even cheaper and there are more years of healthy life gained,” Finley notes, “when you do good risk assessment.”
Current eligibility indicators for most low-dose CT screening programs are those 55-74 years of age with a smoking history of 20 years. Some physicians recommend scans for patients with a relative who has lung cancer or those with documented exposure to radon gas or other workplace contaminants.
So why does it lag?
Finley has spent his career navigating the intersection of medicine, policy and something less tangible: shame. Lung cancer, more than any other common cancer, is burdened by stigma. It is treated as a moral failing rather than a disease. That stigma, he says, is killing people.
That stigma, he says, is killing people.
Almost half the population smoked in the 1960s. Smoking was ubiquitous, normalized and glamorous. Today, lung cancer patients are judged for decisions made in a different cultural moment, decades earlier. The result is a moral hierarchy of disease, one Finley compares to society’s reluctance to fund treatment for obesity.
“People don’t value it,” he says matter-of-factly. “When its sexy, things change quickly. When people don’t value something, they don’t fund it.”
The consequences are not abstract.
One of the cases that pushed Finley into advocacy still haunts him. One patient arrived with two documents in a folder. The first was a discharge letter from a lung cancer screening trial that had been shut down. The second was a CT scan taken six years later, showing metastatic disease.
That patient should have been screened for years but was not. The patient did not die because the Canadian health-care system lacked solutions but because the system walked away.
Meanwhile, treatment has continued to advance. Modern imaging, precise staging, minimally invasive surgery, immunotherapy and targeted drugs have transformed outcomes, even for patients with advanced disease. More people are surviving. More people are living longer with fewer side effects. What has not changed is the lingering belief that lung cancer is self-inflicted and therefore less deserving of care.
Basically, we’re letting people die of shame.
Early-stage lung cancer is far less expensive to treat than late-stage disease. Less expensive by a factor of 10 if measured in dollars and immeasurable when calculated in emotional pain. This has been demonstrated repeatedly by both Canadian and international studies. Yet screening programs remain patchwork, defended by vague references to resource constraints or competing priorities. Those arguments do not withstand scrutiny.
The barrier to universal lung cancer screening is not evidence, cost or feasibility. It is stigma, reinforced by implicit moral judgments that would be unthinkable in other areas of medicine.
“Physicians don’t make moral decisions when we treat disease,” Finley says. “Neither should politicians.”
The Canadian Cancer Society (CCS) has led the development of a Pan-Canadian Lung Cancer Action Plan, which identifies early detection screening as a key strategic priority. CCS affirms that health-care decisions should be guided by scientific evidence and the principles of patient welfare rather than moral or social judgments about individual behaviour.
“Stigma exacerbates inequities and makes it harder for patients to get the care they need and compassion they deserve,” says Annemarie Edwards, Vice President, Cancer Strategy and Innovation at CCS and a Co-Chair with Finley on Canada’s Lung Cancer Action Plan. “It’s time to break down barriers to ensure access for all to expanded screening programs, innovative treatments and the highest standard of care,”
Lung cancer screening should be available to everyone at risk, regardless of where they live or the source of their illness.
Call your elected official and make the case for lung screening. Nobody deserves this death sentence.
