A narrative review of lung cancer screening implementation: increasing utilization of evidence-based practice

Abstract

Cancer is the second leading cause of death in the United States, with lung cancer causing more cancer deaths annually than any other primary site. The high mortality is, in part, due to the lack of symptoms during early stage disease. There is therefore a resultant delay in diagnosis until lung cancer has progressed to later stages, when fewer if any potentially curative options exist. Low-dose computed tomography (LDCT) scanning for screening of high-risk patients has been found to identify lung cancer at earlier stages, and this has corresponded both with an increase in curative intervention and a decrease in lung cancer mortality. Although lung cancer screening carries a relatively low risk of harm, it remains underutilized. The rates of eligible patients that undergo lung cancer screening varies regionally, with rates of screening ranging from less than 4% of eligible patients up to 18% in some states. This low rate of screening has persisted over the past few years despite recommendations for lung cancer screening from national and international organizations. Improving utilization rates requires identification of barriers to screening and strategies to resolve these barriers. As screening utilization rates increase, continued improvement in rates of early diagnosis and mortality from lung cancer would then be expected to follow.