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ALA, ATS Seek Increase in Lung Cancer Screenings With New Healthcare Guide

Allison Inserro
An estimated 25,000 Americans who are at high risk for developing lung cancer would be saved annually through low-dose computed tomography (CT) scans, but only 5% of people who qualify are screened. In an effort to increase the number of people getting screened, the American Lung Association (ALA) and the American Thoracic Society (ATS) unveiled a Lung Cancer Screening Implementation Guide during Lung Cancer Awareness Month.
An estimated 25,000 Americans who are at high risk for developing lung cancer would be saved annually through low-dose computed tomography (CT) scans, but only 5% of people who qualify are screened. In an effort to increase the number of people getting screened, the American Lung Association (ALA) and the American Thoracic Society (ATS) unveiled a Lung Cancer Screening Implementation Guide during Lung Cancer Awareness Month.

The step-by-step guide is intended to help community hospitals and healthcare systems design, implement, and conduct low-dose CT screening programs for lung cancer. The guide was developed though a panel of experts convened by the ALA and ATS and includes detailed, question-and-answer style information about starting a lung cancer screening program, radiology requirements, shared decision making, requirements for program navigation and data tracking, and other details.

Andrea McKee, MD, one of the authors of the guide, discussed the screening issue in an interview with The American Journal of Managed Care®There are a number of hurdles to overcome in setting up such a program, and the guide is intended to give concrete advice to overcome those barriers to screening, she said.

“It’s a pretty big endeavor,” said McKee. “It touches on so many areas of the organization.” That includes different business units for areas such as radiology, surgery, pulmonary, cardiology, internal medicine, oncology, and pathology, which may be more attuned to working in silos as opposed to collaborating in a broad screening program.

McKee, the division chief of radiation oncology at Lahey Hospital and Medical Center in Burlington, Massachusetts, noted that 430 people a day die from lung cancer, the number one cause of all cancer deaths in the United States. The 25,000 who could be saved each year assumes that they would have access to lung cancer screening, which is not the case.

While the number of designated lung cancer screening centers increased from an estimated 203 in 2014 to 1748 in early 2017, according to the CDC, large swaths of the country do not have access to such a center within a 30-minute drive. Some of those geographic areas correspond to regions that have high lung cancer mortality, but also have low access to screening centers.

Who qualifies for screening?
Lung cancer screening is recommended for those considered at high risk, which includes anyone age 55 to 80 who is a current smoker or who quit smoking in the last 15 years and smoked the equivalent of 30 pack years (defined as 1 pack a day for 30 years, 2 packs for 15 years, or any combination of years and packs that equals 30).

Many people who receive a diagnosis of lung cancer think it automatically has a deadly prognosis, McKee said. However, she likened lung cancer screening to mammography for breast cancer. “Like mammography, the earlier [the cancer] is found, the more easily cured it is,” she said.

Because most patients with lung cancer are not diagnosed until it is advanced, the survival rate at 5 years is poor—about 17% or 18%. But in a screening center population, rates are improved, she noted. About 85% of lung cancers discovered via screening are found at stage I or stage II; at stage I, there is a 90% cure rate, she said.



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