Lung Cancer Screenings — Winning Battles in the Lung Cancer War

Background: According to Morgan,¹ “Lung Cancer is the leading cause of cancer-related death in the United States, claiming more lives than colon, breast, and prostate cancer combined.” A projected “222,500 people will be diagnosed with lung cancer in 2017, and 155,870 will die from this disease.” Moyer² reiterates that “nearly 90% of persons with lung cancer die of the disease. However, early-stage non–small cell lung cancer has a better prognosis and can be treated with surgical resection.”

Purpose: To prove low-dose computed tomography (LDCT) lung screenings provide benefit in the early detection and treatment of lung cancer.

Methods: The Medicare eligibility guidelines for screening are: Patients aged 55 to 77 years who currently smoke or have quit within the last 15 years with a tobacco smoking history equal to at least 30 pack-years. Ordering physicians must verify that the patient meets the screening guidelines as well as sign an attestation certifying that the patient has participated in a shared decision-making session, has been informed of the importance of adherence, has been offered smoking cessation, and is asymptomatic. HCA Midwest facilities are ACR (American College of Radiology) accredited and use approved low-dose screening techniques. All sites are participating in the ACR National Radiology Data Registry for lung screening, “which will help benchmark outcomes and process of care measures and develop quality improvement programs” (www.acr.org). For the period of January 2016 to June 2017, data were obtained by each HCA Midwest facility participating in LDCT lung screenings. All screenings were read using the lung reporting and data system (Lung-RADS) classification method. Utilizing LungView software, reports were obtained by month and included the Lung-RADS classification.

Results: HCA Midwest facilities had 221 lung screenings from January to December 2016 with 16 Lung-RADS 4 designations and 4 positive lung cancer diagnoses, a 1.8% diagnosis rate. From January to June 2017, the same facilities had 126 screenings with 11 Lung-RADS 4 designations and 4 diagnosed lung cancers, a 3% diagnosis rate.

Conclusion: Lung cancer screening programs are a valuable tool in preventive medicine. The data show that we are seeing benefit and expect that as the number of screenings increases, so will the number of cancers diagnosed. As Moyer’s research indicated, patients with earlier diagnosis have a better prognosis.² When assessing survival statistics, Morgan states that “Low-dose CT scan is the only screening test that has been found to lower the risk of dying from lung cancer.”¹

Implications/Limitations: Our study was limited by sample size due to the recent implementation of screening programs for high-risk patients. As we see more physicians make recommended practice changes, numbers will increase and provide more robust data for study. Simmons et al³ stated “as compared to chest x-ray, low-dose computed tomography has demonstrated greater sensitivity resulting in lung cancer diagnosis at an earlier stage, thereby reducing lung cancer mortality among high-risk individuals by 20%.” The article also cited the barriers of PCP knowledge of programs, cost and insurance, and false-positive potentials as limitations of screening programs.³

References

1. Morgan L. Should You Be Tested for Lung Cancer? Conquer: the patient voice. https://conquer-magazine.com/tested-lung-cancer.
2. Moyer VA. Screening for Lung Cancer: US Preventive Services Task Force recommendations statement. Ann Intern Med. 2014;160:330-338.
3. Simmons VN, Gray JE, Schabath MB, et al. High-risk community and primary care providers knowledge about and barriers to low-dose computed topography lung cancer screening. Lung Cancer. 2017;106:42-49.