CME: Low-Dose CT for Lung Cancer Screening

CME: Low-Dose CT for Lung Cancer Screening

The American Thoracic Society and American College of Chest Physicians recently developed a policy statement on the successful implementation of comprehensive low-radiation-dose CT (LDCT) lung cancer screening programs that are safe, effective, and sustainable. This type of screening has been shown to reduce risks for lung cancer-related mortality. However, there is a continued need for guidance in this area. LDCT screening is a complex process, and few healthcare providers have experience managing the challenges that come with starting these programs. “There is an important need for an infrastructure for the initial screening CT scan as well as for the evaluation of pulmonary nodules and other abnormalities that are commonly detected on screening,” says Renda Soylemez Wiener, MD, MPH, who helped develop the policy statement document. “There is also a need to be prepared to treat any cancers that may be detected.” The policy statement refers to three phases of LDCT lung cancer screening program development: 1) planning, 2) implementation, and 3) maintenance.   Planning “For the planning phase, we recommend the coordination of a multidisciplinary steering committee to oversee the screening program,” says Dr. Wiener. “This includes representation from pulmonology, thoracic surgery, radiology, primary care, medical center leadership, oncology, and radiation oncology. We also recommend educating and engaging primary care providers to ensure they understand the nuances of lung cancer screening. In most cases, primary care providers will be the ones who need to offer lung cancer screening to their patients. They will also need to be involved in the shared decision-making process required by Medicare.” Dr. Wiener explains that obtaining buy-in from local leadership is important in order to...
Low-Dose CT for Lung Cancer Screening

Low-Dose CT for Lung Cancer Screening

The American Thoracic Society and American College of Chest Physicians recently developed a policy statement on the successful implementation of comprehensive low-radiation-dose CT (LDCT) lung cancer screening programs that are safe, effective, and sustainable. This type of screening has been shown to reduce risks for lung cancer-related mortality. However, there is a continued need for guidance in this area. LDCT screening is a complex process, and few healthcare providers have experience managing the challenges that come with starting these programs. “There is an important need for an infrastructure for the initial screening CT scan as well as for the evaluation of pulmonary nodules and other abnormalities that are commonly detected on screening,” says Renda Soylemez Wiener, MD, MPH, who helped develop the policy statement document. “There is also a need to be prepared to treat any cancers that may be detected.” The policy statement refers to three phases of LDCT lung cancer screening program development: 1) planning, 2) implementation, and 3) maintenance.   Planning “For the planning phase, we recommend the coordination of a multidisciplinary steering committee to oversee the screening program,” says Dr. Wiener. “This includes representation from pulmonology, thoracic surgery, radiology, primary care, medical center leadership, oncology, and radiation oncology. We also recommend educating and engaging primary care providers to ensure they understand the nuances of lung cancer screening. In most cases, primary care providers will be the ones who need to offer lung cancer screening to their patients. They will also need to be involved in the shared decision-making process required by Medicare.” Dr. Wiener explains that obtaining buy-in from local leadership is important in order to...
Guidelines for CT Use in Lung Cancer Screening

Guidelines for CT Use in Lung Cancer Screening

In August 2011, results of the National Lung Screening Trial (NLST) were published in the New England Journal of Medicine. The study found that low-dose CT (LDCT) screening correlated with a reduction in lung cancer-specific mortality of 20% when compared with radiography. In September 2011, the American Association of Thoracic Surgeons (AATS) launched a task force to interpret NLST and several similar European trials in order to establish guidelines on lung cancer screening. The resulting recommendations were recently published in the Journal of Thoracic and Cardiovascular Surgery. The AATS recommendations for use of LDCT in lung cancer screening were most heavily influenced by NLST. The study was specifically designed to answer whether LDCT could positively affect mortality risk for 30 pack-year smokers aged 55 to 74 with a baseline 10-year risk of 2% for developing lung cancer. The NLST also heavily influenced guidelines from other professional societies on LDCT screening. A Tiered Approach for Lung Screening The AATS guidelines use a three-tiered approach. In tier one, it recommends annual LDCT screening from age 55 to 79 for those with a 30 pack-year smoking history. The AATS recommends continuing screening to age 79 because: • The peak incidence of lung cancer in the United States is age 70. • The average life expectancy in the U.S. is 78.6 years. • Age alone is a risk factor for lung cancer. The AATS recommends that screening cease at age 79 because the advantages of early detection are unclear among those aged 80 or older.   Tier two includes yearly LDCT screening for patients as young as 50 with a 20 pack-year history of smoking and an...