Grant: DRA : Canada Graduate Research Scholarship - Doctoral Program (CGRS D)

Lung cancer is the leading cause of cancer death. One reason is that it's often found late, when treatments are less effective. Several Canadian provinces now run lung cancer screening programs to help find cancers earlier. These programs decide who to invite by estimating a person's risk of lung cancer. But risk patterns are changing-for example, rates are rising among some groups such as women and people who have never smoked-and current tools may miss people who would benefit. People living with chronic obstructive pulmonary disease (COPD), a long-term lung condition, face a much higher chance of developing lung cancer. Yet today's screening tools were not built specifically for them. My research asks a simple question: would a lung cancer screening approach tailored to people with COPD work better than the "one-size-fits-all" method? To find out, the study will: Test and update a widely used lung cancer risk calculator so it more accurately predicts risk for people with COPD, using a large primary-care database. Determine the best risk cutoff for offering screening, high enough to catch cancers early, but not so low that it causes unnecessary tests and worry. Check whether this COPD-focused approach is good value for money in Canada by simulating different screening strategies and estimating earlier detections, deaths prevented, years of good health gained, and costs. By sharpening who gets invited to screening, this research aims to reduce missed cancers, avoid unnecessary scans, save healthcare dollars, and lessen harms. The findings can directly support provincial and national policy decisions and, most importantly, promote more equitable access to and effective lung cancer care for Canadians at highest risk.