Lung Cancer Screening: Insights from a Thriving Clinical Practice
- 8 Downloads
Purpose of Review
Lung cancer is the leading cause of cancer deaths in the USA. Computed tomography (CT) offers the potential for early detection by screening asymptomatic high-risk patients. We aimed to review the benefits and potential harms of lung cancer screening, discuss the logistics of a screening program, and provide insight from our own experience.
The National Lung Screening Trial (NLST), a large population-based study, has demonstrated mortality benefit from screening, but relatively few eligible patients currently participate. An effective screening program requires input and cooperation from multiple stakeholders. Effort should be made to actively engage patients in the process including a thorough discussion of benefits and possible harms. At our institution, this approach has resulted in a rapidly growing and sustainable program.
Lung cancer screening has proven mortality benefit in high-risk patients but is underutilized. Developing and growing a screening program is a complex process requiring coordination among multiple specialties with a focus on patient autonomy.
KeywordsLung cancer screening Low-dose chest CT Lung-RADS
The authors thank Mona Hemingway, BSN, RN.
Compliance with Ethical Standards
Conflict of Interest
Michael Burch, Sangita Kapur, and Sandra Starnes declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 5.•• National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395–409. This study reports the results of the National Lung Screening Trial demonstrating reduced mortality with screening low-dose CT. CrossRefGoogle Scholar
- 6.De Koning H, Van Der Aalst C, Ten Haaf K, Oudkerk M. Effects of volume CT lung cancer screening: mortality results of the NELSON randomised-controlled population based trial. 2018 World Conference on Lung Cancer. Abstract PL02.05. Presented September 25, 2018.Google Scholar
- 8.Kazerooni EA, Austin JH, Black WC, Dyer DS, Hazelton TR, Leung AN, McNitt-Gray MF, Munden RF, Pipavath S; American College of Radiology; Society of Thoracic Radiology. ACR-STR practice parameter for the performance and reporting of lung cancer screening thoracic computed tomography (CT): 2014 (Resolution 4). J Thorac Imaging 2014;29(5):310–316.Google Scholar
- 9.Wiener RS, Gould MK, Arenberg DA, Au DH, Fennig K, Lamb CR, Mazzone PJ, Midthun DE, Napoli M, Ost DE, Powell CA, Rivera MP, Slatore CG, Tanner NT, Vachani A, Wisnivesky JP, Yoon SH; ATS/ACCP Committee on Low-Dose CT Lung Cancer Screening in Clinical Practice. An official American Thoracic Society/American College of Chest Physicians policy statement: implementation of low-dose computed tomography lung cancer screening programs in clinical practice. Am J Respir Crit Care Med 2015;192(7):881–891.Google Scholar
- 15.Chiles C, Duan F, Gladish GW, Ravenel JG, Baginski SG, Snyder BS, DeMello S, Desjardins SS, Munden RF1; NLST Study Team. Association of Coronary Artery Calcification and Mortality in the National Lung Screening Trial: a comparison of three scoring methods. Radiology. 2015;276(1):82–90.Google Scholar
- 16.Johnson EB. Methods for text mining in radiology. 2016 May. Retrieved from https://etd.ohiolink.edu/!etd.send_file?accession=case1459514073
- 20.Bushberg JT, Seibert JA, Leidholdt EM, Boone JM. The essential physics of medical imaging. 2nd ed; 2002.Google Scholar
- 22.•• Pinsky PF, Gierada DS, Black W, Munden R, Nath H, Aberle D, et al. Performance of lung-RADS in the National Lung Screening Trial: a retrospective assessment. Ann Intern Med. 2015;162(7):485–91. Demonstrates significant reduction in false-positive screens with Lung-RADS retrospectively applied to the NLST. CrossRefGoogle Scholar