5 Things About Lung Cancer Screening Guidelines and Programs

Over the past year, there have been multiple studies published on the outcomes of various lung cancer screening guidelines and programs. Here are the findings from 5 of those studies and their recommendations.

1. Lung cancer is underrecognized in nonsmokers

In a recently published study, researchers found that lung cancer in people who have never smoked is “under recognized and presents a diagnostic challenge, particularly for [general practitioners] seeking to balance over-investigation with early diagnosis and high-quality care.” The study authors identified major causes of lung cancer in nonsmokers to include secondhand smoke, occupational carcinogen exposure, and outdoor pollution. In fact, on a global level, the study found that the use of solid fuels for indoor cooking and secondhand smoke exposure are significant contributions to lung cancer in nonsmokers, notably disproportionately affecting women.

2. Risk-targeted lung cancer screening shows only modest benefits

Although risk targeting may improve screening efficiency in terms of early lung cancer mortality per person screened, the gains in efficiency are modest in terms of life-years, quality-adjusted life-years (QALYs), and cost-effectiveness, according to a study published last year. The results showed that participants at the highest baseline risk of death from lung cancer achieved the greatest benefit in terms of lung cancer deaths prevented by low-dose computed tomography (LDCT) in the first years after the screening began: 80% of lives can be saved by targeting the highest-risk 60%. However, the study also found that the higher-risk participants were older, had greater smoking exposure, and were more likely to have a pre-existing diagnosis of chronic obstructive pulmonary disease. This led researchers to conclude that applying this type of risk model is unlikely to lead to a substantial improvement in the cost-effectiveness of LDCT screening in terms of QALYs gained per unit cost.

3. ALA and ATS launched a lung cancer screening implementation guide late last year

In an effort to increase the number of people screened for lung cancer, the American Lung Association (ALA) and the American Thoracic Society (ATS) released a Lung Cancer Screening Implementation Guide during Lung Cancer Awareness Month last year. According to the release, an estimated 25,000 Americans at high risk for developing lung cancer could be saved annually through LDCT scans, but only 5% of individuals who qualify are actually screened. The release included a step-by-step guide intended to assist community hospitals and healthcare systems design, implement, and conduct LDCT screening programs for lung cancer. The guide also included information regarding reimbursement and the next steps for implementation of the process.

4. National lung cancer screening guidelines were deemed insufficient for minorities

Researchers evaluated data collected from a lung cancer screening program at the University of Illinois at Chicago (UIC) last year and found that the national lung cancer screening guidelines, which were developed based on the National Lung Screening Trial (NLST) in 2011 and recommend screening based on individuals’ age and smoking history, may be insufficient for those in underrepresented communities. The results showed that when compared with patients in the NLST, patients enrolled in the UIC screening program had a higher percentage of black (69.6% vs 4.5%) and Latino (10.6% vs 1.8%) individuals. In addition, the UIC program also had double the number of positive scans (24.6% vs 13.7%) and a higher percentage of diagnosed lung cancer cases (2.6% vs 1.1%). While it is undisputed that lung cancer screening is effective, the study authors concluded that the guidelines should incorporate more expansive, risk-based screening in order to address racial disparities in lung cancer outcomes.

5. Lung cancer screening is more complicated than originally thought

In a study published in The American Journal of Managed Care^® last year, authors reported on a demonstration project among current and former smokers who were screened in the Minneapolis Veterans Affairs Health Care System. Among other findings, the researchers reported that electronic health records don’t always record information about patient tobacco package-years, an important piece of information used to gauge eligibility for screening; calling patients in addition to outreach through the mail made a difference, as 22% of those who received a phone call were screened compared with 9% who were only contacted by mail; and there were 179 “incidental” findings among 116 patients, of which 20% were clinically significant. The authors concluded that their research shed light on the challenges of getting a large cohort of potentially eligible current and former smokers through the annual screening process.