Computed Tomography Screening for the Early Detection of Lung Cancer

2006 ◽  
Vol 4 (6) ◽  
pp. 591-594 ◽  
Author(s):  
Rebecca P. Petersen ◽  
David H. Harpole
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Survival Rate ◽  
Screening Tool ◽  
Lung Cancer Screening ◽  
Spiral Ct ◽  
The United States ◽  
Lung Cancers ◽  
The Past ◽  
Stage Ia

Although lung cancer is the leading cause of cancer-related death in the world and has an increased chance of cure if detected at an earlier stage, routine lung cancer screening is currently not recommended in the United States. Unfortunately, most patients with lung cancer present only after the onset of symptoms and have advanced disease that cannot be surgically resected. The overall 5-year survival rate for all patients with lung cancer is only 15%. When the cancer is detected at its earliest stage (pathologic stage IA), however, the 5-year survival rate is more than 70%. Although past randomized screening trials evaluating the use of standard chest radiography or sputum cytology have not resulted in lower mortality, recent studies suggest that computed tomography (CT) may have promise as a screening tool. This article summarizes experience over the past decade of using low-dose spiral CT imaging as a screening tool to detect early lung cancers in asymptomatic, high-risk individuals.

scholarly journals Effectiveness of Lung Cancer Screening Implementation in the Community Setting in the United States

2019 ◽  
Vol 15 (7) ◽  
pp. e607-e615 ◽  
Author(s):  
Amy Copeland ◽  
Angela Criswell ◽  
Andrew Ciupek ◽  
Jennifer C. King
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Cancer Screening ◽  
Low Dose ◽  
Community Setting ◽  
Lung Cancer Screening ◽  
The United States ◽  
Community Based ◽  
Lung Cancers ◽  
Low Dose Computed Tomography

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.

Effectiveness of mobile computerized tomographic (CT) lung scanning unit for early diagnosis of lung cancer in under-served populations.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6567-6567
Author(s):  
Derek Raghavan ◽  
Darcy L Doege ◽  
Mellisa S Wheeler ◽  
John D Doty ◽  
James Oliver ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Low Dose ◽  
Lung Cancer Screening ◽  
The United States ◽  
Lung Cancers ◽  
Low Dose Ct ◽  
Screening Unit ◽  
Lung Screening ◽  
Lung Scanning

6567 Background: The National Lung Screening Trial (NLST) demonstrated that screening high-risk patients with low-dose CT (LDCT) of the chest reduces lung cancer mortality compared to screening with chest x-ray. Uninsured and Medicaid patients lack access to this hospital-based screening test due to geographic isolation/socio-economic factors. We hypothesized that a mobile screening unit would improve access and confer benefits demonstrated by the NLST to this under-served group, which is most at risk of lung cancer deaths. Methods: In collaboration with Samsung Inc, we inserted a BodyTom portable 32 slide low-dose CT scanner into a 35-foot coach, reinforced to avoid equipment damage, to function as a mobile lung scanning unit. The unit includes a waiting area, high speed wireless internet connection for rapid image transfer, and electronic tablets to deliver smoking cessation and health education programs and shared decision-making video aids. It has been certified as a lung cancer screening Center of Excellence by Lung Cancer Alliance. We employed the LUNG RADS approach to lesion classification, yielding high sensitivity and specificity in assessment. All films were reviewed by a central panel of oncologists, pulmonologists and radiologists. The protocol was approved by Chesapeake IRB, which oversees all LCI cancer trials. Interim analysis at this time was approved by the Oversight Committee. Results: We screened 470 under-served smokers between 4/2017-1/2019; M:F 1.1:1, mean age 61 years (range 55-64), with average pack year history of 45.7 (30-150) (25% African-American; 3% Hispanic; 65% rural; 100% uninsured, under-insured or Medicaid - NC Medicaid does not cover lung cancer screening). Patients over the age of 64 years were excluded as they are covered by Medicare for lung cancer screening. We found at initial screen 35 subjects with LUNG RADS 4 lesions, 49 subjects with LUNG RADS 3 lesions, 10 lung cancers (2.1%), including 4 at stage I-II. 4 non-lung cancers were identified and treated. Other incidental non-oncologic findings are the subject of another presentation. Conclusions: In this small sample using the first mobile low dose CT lung screening unit in the United States, the initial cancer detection rate is comparable to that reported in the NLST but with marked improvement of screening rates in underserved groups and with better anticipated outcomes at lower cost than if they had first presented with metastatic disease.

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

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.

Lung Cancer Screening with Low-Dose Spiral Computed Tomography

2005 ◽  
Vol 71 (12) ◽  
pp. 1015-1017 ◽  
Author(s):  
S.M. Stephenson ◽  
K.F. Mech ◽  
A. Sardi
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Screening Tool ◽  
Community Setting ◽  
Squamous Carcinoma ◽  
Lung Cancer Screening ◽  
Chest Ct ◽  
Smoking History ◽  
Ct Guided ◽  
Study Results

Computed tomography (CT) has been compared to plain radiographs and bronchial washings as a screening tool for lung cancer. In comparison with other screening modalities, CT allows detection of lung lesions at an earlier cancer stage. Technologic improvements have decreased imaging costs, thus making chest CT a more feasible option as a screening tool in the community hospital. In this study, smokers over the age of 45 years with a greater than 20 pack-year smoking history were referred for screening chest CT. Noncalcified nodules larger than 10 mm underwent CT-guided biopsy, and smaller nodules underwent follow-up CT in 3 months. Currently, patients have been followed for 4 years. The prevalence, stage, and histology of lung cancer were compared to study results from academic centers. Eighty-seven patients underwent screening chest CT. The study population was 51 per cent male with a mean age of 64 ± 9 years. Four (3 female and 1 male) patients were biopsied and found to have lung cancer giving a prevalence of 5 per cent. Stage IA disease was found in three patients and stage IIIA disease was found in one patient. Adenocarcinoma was present in two patients, adeno-squamous carcinoma in one patient, and squamous cell carcinoma in one patient. The stage and histology of lung carcinomas in this study were comparable to studies performed at larger institutions. However, the disease prevalence was almost double the highest prevalence found in other studies. This discrepancy could be related to study size, as the patient populations were similar. Clearly, screening chest CT in the community setting is equally efficacious in the diagnosis of lung cancer at earlier stages. Following these patients beyond the 5-year mark will give some insight on the effect of screening chest CT on the mortality of lung cancer.

Barriers to Lung Cancer Screening With Low-Dose Computed Tomography

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.

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

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.

scholarly journals Geographic Availability of Low-Dose Computed Tomography for Lung Cancer Screening in the United States, 2017

2018 ◽  
Vol 15 ◽  
Author(s):  
Jan M. Eberth ◽  
Parisa Bozorgi ◽  
Logan M. Lebrón ◽  
Sarah E. Bills ◽  
Linda J. Hazlett ◽  
...  
Keyword(s):  
United States ◽  
Computed Tomography ◽  
Lung Cancer ◽  
Cancer Screening ◽  
Low Dose ◽  
Lung Cancer Screening ◽  
The United States ◽  
Low Dose Computed Tomography
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