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20 Minutes on Lung Cancer Screening

Lung Cancer Screening Figure
Reprinted with permission of the American
Thoracic Society. Copyright © 2015 American Thoracic Society.
David E. Ost and Michael K. Gould, Decision Making in
Patients with Pulmonary Nodules, Am J Respir Crit Care Med,
Vol. 185, No. 4 (2012), pp. 363-372.
Official Journal of the American Thoracic Society.

In 2011, the National Lung Screening Trial (NLST) provided us with high-quality evidence in support of lung cancer screening, demonstrating a 20% relative reduction in mortality for high risk individuals who underwent annual low-dose CT screening.  However, we also know from the NLST and other studies, that lung cancer screening can cause harms.  The question is how medical centers that want to start offering lung cancer screening can develop and implement screening programs that maximize the benefits of lung cancer screening while minimizing the harms.

Implementation of lung cancer screening is a very hot topic right now because of two policy changes that will start in 2015. First, due to mandates of the Affordable Care Act, private insurers will be required to cover lung cancer screening for high risk individuals that meet criteria proposed in the US Preventive Services Task Force guidelines. Second, the Centers for Medicare and Medicaid Services (CMS) has also proposed covering lung cancer screening for eligible Medicare beneficiaries.

Specifically, CMS recently issued a preliminary decision proposing to cover lung cancer screening for Medicare beneficiaries who meet the inclusion criteria used in the NLST – namely individuals aged 55-74 years with at least a 30-pack year history of cigarette smoking and tobacco use within the past 15 years (http://www.cms.gov/medicare-coverage-database/details/nca-proposed-decision-memo.aspx?NCAId=274).  CMS also proposed a number of additional requirements designed to ensure that the benefits of screening outweigh the harms in the Medicare population. These additional criteria for coverage include a shared decision-making visit in which patients are counseled on the trade-offs of lung cancer screening, counseling for smoking cessation if relevant, and the requirement that programs upload information on individuals who have undergone screening to a central registry to ensure screening is safe and effective.

The ATS and the Thoracic Oncology Assembly is committed to helping patients, clinicians, healthcare systems, and payers obtain high quality lung cancer screening that maximizes the benefits and minimizes the risk.  The goal of our joint statement with the American College of Chest Physicians, based on expert opinion and the best available evidence, is to provide a blueprint for centers starting their own program.  In this podcast, Drs. Mazzone and Wiener discuss this statement and outline their thoughts for how to implement a successful screening program that is safe and effective.

Thanks for listening!

Charles A Powell, MD; Chair
Michael K. Gould, MD MS; Incoming Chair

*If you are unable to play the audio please click here to download the file.

Reference:

  1. Mazzone P, Powell CA, Arenberg D, Bach P, Detterbeck F, Gould M, Jaklitsch MT, Jett J, Naidich D, Vachani A, Wiener RS, Silvestri G. Components necessary for high quality lung cancer screening: American college of chest physicians and american thoracic society policy statement. Chest 2014.
  2. Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, Gareen IF, Gatsonis C, Marcus PM, Sicks JD. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011;365:395-409.
  3. Humphrey LL, Deffebach M, Pappas M, Baumann C, Artis K, Mitchell JP, Zakher B, Fu R, Slatore CG. Screening for lung cancer with low-dose computed tomography: A systematic review to update the u.S. Preventive services task force recommendation. Ann Intern Med 2013;159:411-420.
  4. Slatore CG, Sullivan DR, Pappas M, Humphrey LL. Patient-centered outcomes among lung cancer screening recipients with computed tomography: A systematic review. J Thorac Oncol 2014;9:927-934.
  5. Slatore CG, Baumann C, Pappas M, Humphrey LL. Smoking behaviors among patients receiving computed tomography for lung cancer screening. Systematic review in support of the u.S. Preventive services task force. Ann Am Thorac Soc 2014;11:619-627.
Last Reviewed: June 2016