Projected Clinical, Resource, and Budget Impact of Implementing Low-Dose Computed Tomography Lung Cancer Screening in the United States

PURPOSE: The National Lung Screening Trial demonstrated a 20% relative reduction in lung cancer mortality with low-dose computed tomography screening, leading to implementation of lung cancer screening across the United States. The Centers for Medicare and Medicaid Services approved coverage, but questions remained about effectiveness of community-based screening. To assess screening implementation during the first full year of CMS coverage, we surveyed a nationwide network of lung cancer screening centers, comparing results from academic and nonacademic centers. METHODS: One hundred sixty-five lung cancer screening centers that have been designated Screening Centers of Excellence responded to a survey about their 2016 program data and practices. The survey included 21 pretested, closed- and open-ended quantitative and qualitative questions covering implementation, workflow, numbers of screening tests completed, and cancers diagnosed. RESULTS: Centers were predominantly community based (62%), with broad geographic distribution. In both community and academic centers, more than half of lung cancers were diagnosed at stage I or limited stage, demonstrating a clear stage shift compared with historical data. Lung-RADS results were also comparable. There are wide variations in the ways centers address Centers for Medicare and Medicaid Services requirements. The most significant barriers to screening implementation were insurance and billing issues, lack of provider referral, lack of patient awareness, and internal workflow challenges. CONCLUSION: These data validate that responsible screening can take place in a community setting and that lung cancers detected by low-dose computed tomography screening are often diagnosed at an early, more treatable stage. Lung cancer screening programs have developed different ways to address requirements, but many implementation challenges remain.

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State Variation in Low-Dose Computed Tomography Scanning for Lung Cancer Screening in the United States

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djaa170 ◽

2020 ◽

Author(s):

Stacey A Fedewa ◽

Ella A Kazerooni ◽

Jamie L Studts ◽

Robert A Smith ◽

Priti Bandi ◽

...

Keyword(s):

United States ◽

Computed Tomography ◽

Lung Cancer ◽

Cancer Screening ◽

Cancer Mortality ◽

Low Dose ◽

Lung Cancer Screening ◽

Lung Cancer Mortality ◽

The United States ◽

Cancer Burden

Abstract Background Annual lung cancer screening (LCS) with low-dose chest computed tomography in older current and former smokers (ie, eligible adults) has been recommended since 2013. Uptake has been slow and variable across the United States. We estimated the LCS rate and growth at the national and state level between 2016 and 2018. Methods The American College of Radiology’s Lung Cancer Screening Registry was used to capture screening events. Population-based surveys, the US Census, and cancer registry data were used to estimate the number of eligible adults and lung cancer mortality (ie, burden). Lung cancer screening rates (SRs) in eligible adults and screening rate ratios with 95% confidence intervals (CI) were used to measure changes by state and year. Results Nationally, the SR was steady between 2016 (3.3%, 95% CI = 3.3% to 3.7%) and 2017 (3.4%, 95% CI = 3.4% to 3.9%), increasing to 5.0% (95% CI = 5.0% to 5.7%) in 2018 (2018 vs 2016 SR ratio = 1.52, 95% CI = 1.51 to 1.62). In 2018, several southern states with a high lung-cancer burden (eg, Mississippi, West Virginia, and Arkansas) had relatively low SRs (<4%) among eligible adults, whereas several northeastern states with lower lung cancer burden (eg, Massachusetts, Vermont, and New Hampshire) had the highest SRs (12.8%-15.2%). The exception was Kentucky, which had the nation’s highest lung cancer mortality rate and one of the highest SRs (13.7%). Conclusions Fewer than 1 in 20 eligible adults received LCS nationally, and uptake varied widely across states. LCS rates were not aligned with lung cancer burden across states, except for Kentucky, which has supported comprehensive efforts to implement LCS.

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Faculty Opinions recommendation of Projected Clinical, Resource Use, and Fiscal Impacts of Implementing Low-Dose Computed Tomography Lung Cancer Screening in Medicare.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725470060.793516647 ◽

2016 ◽

Author(s):

David Midthun

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Cancer Screening ◽

Resource Use ◽

Low Dose ◽

Lung Cancer Screening ◽

Fiscal Impacts ◽

Clinical Resource ◽

Low Dose Computed Tomography

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Barriers to Lung Cancer Screening With Low-Dose Computed Tomography

10.1188/19.onf.e60-e71 ◽

2019 ◽

pp. E60-E71

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Cancer Screening ◽

Health System ◽

Low Dose ◽

Lung Cancer Screening ◽

Primary Care Providers ◽

The United States ◽

System Level ◽

Low Dose Computed Tomography

Problem Identification: Despite lung cancer screening guidelines and insurance coverage changes, rates of lung cancer screening with low-dose computed tomography remain suboptimal among the eligible population in the United States. Literature Search: Electronic literature databases, including PubMed, CINAHL®, PsycINFO, and Google Scholar, were searched. Data Evaluation: After applying filter information and inclusion and exclusion criteria, 10 articles were reviewed. Methodological rigor was evaluated. Synthesis: Based on the social–ecological approach, barriers to lung cancer screening at the individual level, including sociodemographic characteristics, financial cost, lack of knowledge, inaccurate beliefs about lung cancer screening, distrust of the medical system, stigma around smoking and lung cancer, negative attitudes about outcomes of lung cancer screening, and inconvenience of receiving lung cancer screening, were identified. Barriers at the health-system level included lack of information from primary care providers. Implications for Practice: Overcoming barriers to lung cancer screening at individual and health-system levels is essential to increase lung cancer screening uptake rates.

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Underutilization of low-dose computed tomography in a high-risk population.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e14145 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e14145-e14145

Author(s):

Sara Ashraf ◽

Venu Madhav Konala ◽

Mohammad Ali Syed Jafri

Keyword(s):

United States ◽

Computed Tomography ◽

Lung Cancer ◽

Low Dose ◽

Community Setting ◽

Lung Cancer Screening ◽

The United States ◽

Number Of Patients ◽

Incidence And Mortality ◽

Low Dose Computed Tomography

e14145 Background: Lung cancer is the leading cause of cancer death in the United States, contributing to one-quarter of all cancer-related deaths. State statistics reveal per capita that Kentucky has the highest incidence and mortality rate for lung cancer. One would assume that in a community setting in Kentucky, the rate of utility of low dose Computed Tomography (CT) and detection of lung cancer would be high. Methods: We did a retrospective analysis of Low Dose Computed Tomography (CT) for lung cancer screening based on the United States Preventative Services Task Force (USPSTF) guidelines from 2017-2019 at a community hospital in Ashland, Kentucky. Charts were reviewed to analyze the number of patients who received screening, total number of patients diagnosed with lung cancer, and how many patients could have received screening based on the guidelines. We also analyzed how many are alive and those that are deceased. Results: Our analysis showed that a total of 175 patients were diagnosed with lung cancer at the hospital in 3 years. Out of these, 118 had qualified for screening (67%) based on USPSTF guidelines. Only seven patients received screening (5.9%). All seven patients who received screening are currently alive. Forty-eight patients (41%) are now deceased that could have had the screening but did not. Conclusions: Low dose screening CT is being underutilized in the community setting with high incidence and mortality from lung cancer. The mortality rate is high likely from the late detection of the tumor. Implementation of guidelines to the general population for lung cancer screening will require systems to facilitate identifying eligible patients. It also involves training of physicians with information that should be delivered during the shared decision-making conversation. We also suggest low dose screening CT to be included in global quality pay for performance program for primary care providers which includes screening for breast and cervical cancer as well as smoking cessation.

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LOW-DOSE COMPUTED TOMOGRAPHY IN MOSCOW FOR LUNG CANCER SCREENING (LDCT-MLCS): BASELINE RESULTS

Problems in oncology ◽

10.37469/0507-3758-2019-65-2-224-233 ◽

2019 ◽

Vol 65 (2) ◽

pp. 224-233

Author(s):

Sergey Morozov ◽

Viktor Gombolevskiy ◽

Anton Vladzimirskiy ◽

Albina Laypan ◽

Pavel Kononets ◽

...

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Cancer Screening ◽

Low Dose ◽

Early Stage ◽

Lung Cancer Screening ◽

Stage I ◽

Malignant Neoplasms ◽

Number Needed To Screen ◽

Low Dose Computed Tomography

Study aim. To justify selective lung cancer screening via low-dose computed tomography and evaluate its effectiveness. Materials and methods. In 2017 we have concluded the baseline stage of “Lowdose computed tomography in Moscow for lung cancer screening (LDCT-MLCS)” trial. The trial included 10 outpatient clinics with 64-detector CT units (Toshiba Aquilion 64 and Toshiba CLX). Special low-dose protocols have been developed for each unit with maximum effective dose of 1 mSv (in accordance with the requirements of paragraph 2.2.1, Sanitary Regulations 2.6.1.1192-03). The study involved 5,310 patients (53% men, 47% women) aged 18-92 years (mean age 62 years). Diagnosis verification was carried out in the specialized medical organizations via consultations, additional instrumental, laboratory as well as pathohistological studies. The results were then entered into the “National Cancer Registry”. Results. 5310 patients (53% men, 47% women) aged 18 to 92 years (an average of 62 years) participated in the LDCT-MLCS. The final cohort was comprised of 4762 (89.6%) patients. We have detected 291 (6.1%) Lung-RADS 3 lesions, 228 (4.8%) Lung- RADS 4A lesions and 196 (4.1%) Lung-RADS 4B/4X lesions. All 4B and 4X lesions were routed in accordance with the project's methodology and legislative documents. Malignant neoplasms were verified in 84 cases (1.76% of the cohort). Stage I-II lung cancer was actively detected in 40.3% of these individuals. For the first time in the Russian Federation we have calculated the number needed to screen (NNS) to identify one lung cancer (NNS=57) and to detect one Stage I lung cancer (NNS=207). Conclusions. Based on the global experience and our own practices, we argue that selective LDCT is the most systematic solution to the problem of early-stage lung cancer screening.

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