Implementation of Lung Cancer Screening

When: June 20, 2016 - June 21, 2016 (8:00 AM Eastern)
Where: Keck Center (100) • 500 Fifth St. NW, Washington, DC 20001

Topics Biomedical and Health Research, Diseases, Health Care Workforce, Health Services, Coverage, and Access, Quality and Patient Safety
Activity: National Cancer Policy Forum
Board: Board on Health Care Services

Lung cancer is the third most common cancer and the leading cause of cancer-related death in the United States. Relative to other types of cancer, lung cancer often has a poor prognosis. The overall 5 year relative survival rate of patients with lung cancer is less than 18%. More than half of lung cancers have distant metastasis at the time of diagnosis and the 5 year relative survival after distant metastasis is less than 5%.

Annual screening of individuals at high risk for lung cancer with low dose computed tomography (LDCT) can prevent a substantial number of lung cancer related deaths by detecting cancer at an earlier stage. Results from the National Lung Screening Trial (NLST) demonstrated a 20% reduction in lung cancer mortality with LDCT screening. In 2013, on the basis of evidence from the NLST, the U.S. Preventive Services Task Force recommended annual lung cancer screening with LDCT for individuals age 55 to 80, with a history of at least 30 pack years of cigarette smoking, and who are either current smokers or had quit within the past 15 years. The USPSTF assigned the recommendation a grade B, indicating moderate certainty that there is a substantial net benefit for LCDT screening in asymptomatic persons who are at high risk for lung cancer. Provisions in the Affordable Care Act intended to promote population health and access to preventive health services require insurers to cover preventive health services with a grade A or B recommendation without cost sharing. As a result, many Americans now have access to LDCT lung cancer screening without a co-pay. In addition, The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to add a lung cancer screening counseling and shared decision making visit, and for appropriate beneficiaries, annual screening for lung cancer with low dose computed tomography (LDCT), as an additional preventive service benefit under the Medicare program if eligibility criteria similar to the NLST trial are met (CMS, 2015).

However, there are many challenges associated with broad implementation of LDCT lung cancer screening in clinical practices because the effectiveness of cancer screening programs depends on many different factors, including patient, provider, and health system factors. As noted by the USPSTF, screening may not be appropriate for some patient populations, such as those with health conditions that substantially limit life expectancy or the ability or willingness to undergo curative lung surgery. High quality image acquisition and accurate interpretation are also necessary to ensure a net benefit of a population-based screening program. Appropriate follow-up of abnormal screening results will be similarly critical when implementing LDCT screening. And yet, the most important risk factor for lung cancer is smoking status and lung cancer screening is not a substitute for smoking cessation, and experts recommend that lung cancer screening programs be implemented in conjunction with smoking cessation programs.

This workshop examined these challenges in the implementation of LDCT lung cancer screening programs and consider potential actions to improve implementation. Workshop participants discussed barriers to implementation of lung cancer screening, strategies for identifying populations eligible for and likely to benefit from screening, decision aids for health care providers and patients, strategies to best provide smoking cessation support, and practical measures for state and national public health surveillance of lung cancer screening. 

Workshop Planning Committee

Greta Massetti, Chair, Centers for Disease Control and Prevention
Lori Hoffman-Hogg, Veterans Health Administration Office of Nursing Services
Samir Khleif, Georgia Regents University Cancer Center
Barnett Kramer, National Cancer Institute
Lee Krug, Bristol-Myers Squibb
Christopher Lathan, Harvard Medical School
Jennifer Pietenpol, Vanderbilt-Ingram Cancer Center
Ya-Chen Tina Shih, MD Anderson Cancer Center
Robert Smith, American Cancer Society
Jamie Studts, University of Kentucky College of Medicine
Daniel Sullivan, Duke University School of Medicine
Robert Volk, MD Anderson Cancer Center

Confirmed Speakers

Denise Aberle, University of California, Los Angeles
Peter Bach, Memorial Sloan Kettering Cancer Center
William Black, Dartmouth-Hitchcock Medical Center
Steven Blumenfrucht, Aetna
Joseph Chin, Centers for Medicare & Medicaid Services
Amy Copeland, Lung Cancer Alliance
V. Paul Doria-Rose, National Cancer Institute
Richard Hoffman, University of Iowa Carver College of Medicine
Ella Kazerooni, University of Michigan
Jane Kim, National Center for Health Promotion and Disease Prevention
Kelly M. Latimer, Naval Hospital Pensacola
Michael LeFevre, University of Missouri
Peter Mazzone, Cleveland Clinic
Ide Mills, Patient Advocate
Jamie Ostroff, Memorial Sloan Kettering Cancer Center
Elyse Park, Harvard Medical School
Joshua Roth, Fred Hutchinson Cancer Research Center
Christopher Slatore, Oregon Health & Sciences University
Fabrice Smieliauskas, University of Chicago
Joanna Stoms, Pennsylvania Department of Health
Martin Tammemägi, Brock University
Kathryn Taylor, Georgetown Lombardi Comprehensive Cancer Center
Douglas Wood, University of Washington

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