Computed Tomography Screening for Lung Cancer

Abstract

CT screening is feasible in a diverse inner-city population with the support of a robust infrastructure. Further study is needed to determine whether CT screening will confer a mortality benefit in this population.

Real-world Clinical Implementation of Lung Cancer Screening—Evaluating Processes to Improve Screening Guidelines-Concordance

“…This is consistent with NLST findings and rates reported by Milch et al and Wilson et al (both 2%) but is slightly higher than the 1-2% lung cancer yield reported by other studies. 3,9,11,12,33 A higher proportion of lung cancers identified via screening at KPCO were diagnosed at potentially curable stages I-IIIA than reported by Lanni et al in a different LCS setting (74.6% vs. 39%). 11 There is a clinically significant trend toward lower rates of advanced cancers in the postcohort, suggesting that more stringent adherence to eligibility criteria may lead to important improvements in screening outcomes.…”

“…Adhering to eligibility guidelines is a common barrier in LCS; McKee et al reported that 18% of patients screened did not meet eligibility criteria, and Milch et al reported that 38% did not meet criteria. 9,12 The most common reason for ineligibility was missing, incomplete, or outdated smoking history data (i.e., smoking status, quit dates, and pack-year history). 32 However, consistent with the findings of Triplette et al, additional provider and health system resources are needed to capture complete smoking history and eligibility for every patient, 35 as was the case for KPCO.…”

“…1 The trial findings, and subsequent recommendations from the US Preventative Services Task Force, 2 resulted in LCS via LDCT being implemented in a variety of community and academic clinical settings. [3][4][5][6][7][8][9][10][11][12] Most LCS programs base eligibility criteria on the US Preventive Services Task Force recommendations (ages 55-80 with ≥ 30 pack-years smoked and smoked in the last 15 years) and the additional Centers for Medicare and Medicaid Services (CMS) payment requirements. 13 Thus, inaccurate or incomplete smoking history documentation in the electronic health record, 3,5,8 incorrectly calculated pack-years, 3,5 and ineligible patients receiving LCS-related LDCT scans [8][9][10] present substantial challenges for implementation, uptake, and evaluation of LCS programs in real-world clinical settings.…”

“…2 Moreover, CMS payment requirements related to shared decisionmaking and smoking cessation support, along with followup testing and handling of incidental findings identified via screening LDCT (S-LDCT), result in additional complexity for LCS workflows. 3,5,6,8,9,12,14,15 The US Preventive Services Task Force "Grade B" recommendation for LCS via LDCT and the Patient Protection and Affordable Care Act requirements necessitated that health systems begin offering S-LDCT scans that require no copays for eligible members in 2013. In 2015, the CMS published a decision memo outlining specific LCS eligibility criteria that needed to be met.…”

Accuracy of baseline low-dose computed tomography lung cancer screening: a systematic review and meta-analysis

“…With reference to the inclusion and exclusion criteria, the literature was initially screened, and 463 papers were eliminated by reading the titles and abstracts. Then, the remaining papers were read in full, 224 papers were excluded, and 48 papers [4,12–58] were finally included. The literature screening process is shown in Figure 1.…”