Ella Kazerooni, MD, MS, FACR, and Ben Wandtke, MD, MS, Physician Co-Advisors for the American College of Radiology® (ACR®) Lung Cancer Screening Registry (LCSR), contributed this piece.

Lung cancer is the leading cause of cancer death in the United States for both among men and women. While lung cancer screening has proven successful in detecting more lung cancers at early more treatable stages in patients at high risk based on age and smoking history, less than half of all patients with lung cancer are eligible for lung cancer screening. Each year, about 10-20% of lung cancers, or 20,000-40,000 lung cancers, happen in people who have never smoked or smoked fewer than 100 cigarettes in their lifetime.

Every day in radiology practices across the nation, lung nodules are detected incidentally on radiology examinations performed for reasons other than nodule detection. When appropriately managed, these nodules provide an important additional opportunity for the early detection of lung cancer. Failure to appropriately manage these incidentally detected nodules results in delays in lung cancer diagnosis, resulting in poorer outcomes for patients and more expensive healthcare.

Data registries such as the LCSR, now entering its 10th year as a quality registry, help practices compare their performance measures with regional and national benchmarks to help identify areas for quality improvement. We’re thrilled for the opportunity to begin expansion of the LCSR with the support of a 12-month planning grant, overseen by the University of California, San Francisco, and the Council of Medical Specialty Societies, and funded by the Gordon and Betty Moore Foundation. The grant is aimed at the development of diagnostic performance feedback for physicians participating in quality improvement registries. It will support the expansion of the LCSR through a module for actionable incidental pulmonary nodule (IPNs). This expansion will help healthcare systems better understand the scope of this problem and gather the data needed to facilitate appropriate and timely follow-up care.

The LCSR will serve as a reliable model to build upon providing ACR members with a familiar user experience. The ACR has been working on the development and testing of performance measures for management of pulmonary nodules for many years now. Several performance measures initially proposed by the Closing the Recommendations Follow-up Workgroup and Technical Expert Panel have been tested in real-world settings by the ACR Learning Network’s Recommendations Follow-up Collaborative. These measures will likely serve as the basis for performance measurement in the IPN module.

As the IPN module and LCSR are both focused on the common goal of increasing early lung cancer detection, we believe this registry expansion is well-aligned with the goals of those already using the registry. We hope to engage many of the nearly 3,000 facilities already actively participating to encourage rapid and widespread adoption and performance improvement to enhance lung cancer screening care at the national level.

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