Lung Cancer Screening Not So Simple, Report in AJMC® Finds

What seems like a straightforward idea—screen current and former heavy smokers for lung cancer—proves more challenging in practice, according to findings from a demonstration project at the Minneapolis Veterans Affairs Health Care System.

CRANBURY, N.J.—Lung cancer screening is free under the Affordable Care Act for certain current and former smokers, after a national study found their risk of cancer death fell 20 percent through annual screening with low-dose computed tomography (LDCT) instead of chest x-rays.

But getting the right people screened in the real world isn’t as simple as it sounds, according to findings in the current issue of The American Journal of Managed Care^®. Authors report on a demonstration project among current and former smokers who were screened in the Minneapolis Veterans Affairs Health Care System. Among their findings:

Electronic health records do not always record information about patient tobacco pack-years, a key piece of information needed to gauge eligibility for screening.
Of 6,133 potentially eligible patients, 1,388 had available tobacco pack-year information. Of this group, 918 were invited for lung cancer screening and 178, or 19 percent, completed screening.
Giving patients a phone call in addition to outreach through the mail made a difference: 22 percent of those with a phone call were screened, compared with 9 percent who only had contact by mail.
Among those who completed LDCT, 61 percent had lung nodules requiring follow-up; 12 patients needed more diagnostic evaluation, and two had lung malignancies.
There were 179 “incidental” findings among 116 patients, and 20 percent were clinically significant.

The research sheds light on the challenges of getting the large pool of potentially eligible current and former smokers through the annual screening process. Just 1.9 percent of eligible smokers were screened in 2016, according to data presented in early June at the American Society of Clinical Oncology.

Criteria from the US Preventive Services Task Force call for screening smokers age 55 to 80 who have smoked at least 30 pack-years, or those with that history who have quit within the past 15 years. Thus, the authors note, getting patients screened requires that health systems have the capacity to capture patient information and track down those who meet the criteria. Health systems also must handle patients who may experience anxiety after a nodule is found, even if it is unlikely to become cancerous.

“Important considerations in lung cancer screening are accurate identification of eligible patients, balancing invitation approaches with resource constraints, and establishing standardized methods for tracking numerous small lung nodules and incidental findings detected by LDCT,” the authors conclude.

“Lung cancer screening implementation presents unique challenges, but they are not insurmountable. With more research and experience, we will find the best method to deliver this important cancer screening intervention to the millions of Americans that need it,” said Angela E. Fabbrini, MPH, lead author and director of the lung cancer screen program in the Minneapolis Veterans Administration Health Care System.

About The American Journal of Managed Care^®:

The American Journal of Managed Care^® (AJMC^®) is a peer-reviewed, MEDLINE-indexed journal that keeps readers on the forefront of health policy by publishing research relevant to industry decision makers as they work to promote the efficient delivery of high-quality care. AJMC.com is the essential website for managed care professionals, distributing industry updates daily to leading stakeholders. Other titles in the AJMC^® family include The American Journal of Accountable Care^®, and two evidence-based series, Evidence-Based Oncology^™ and Evidence-Based Diabetes Management^™. These comprehensive offerings bring together stakeholder views from payers, providers, policymakers and other industry leaders in managed care. To order reprints of articles appearing in AJMC^® publications, please contact Jeff Prescott at 609-716-7777, ext. 331.