We know that annual lung cancer screening (LCS) with low-dose computed tomography (LDCT) in high-risk patients significantly reduces lung cancer deaths.1 This screening can identify cancers at an early, treatable, and curable stage. Given that the American Cancer Society predicts 135,720 lung cancer deaths this year, more-widespread screening could save 30,000–60,000 lives in the U.S. each year.2
Changes outlined in the new draft U.S. Preventive Services Task Force (USPSTF) LCS recommendations will greatly increase the number of Americans eligible for screening and help medical providers save thousands more lives each year. In addition to these new guidelines, the ACR is working to expand screening, particularly among minorities and women. The ACR recommends that to save more lives from lung cancer:
- The USPSTF should lower the starting age for screening from age 55 to age 50 and the smoking history requirements from 30 pack-years to 20 pack-years.
- The USPSTF should extend the quit-smoking requirement from 15 years to 20 years.
- Medical providers must become familiar with LCS guidelines and prescribe these exams for high-risk patients. Today, only a fraction of the recommended population is screened, in part because providers are not ordering appropriate studies.
Lung cancer kills more people each year than breast, colon, and prostate cancers combined.2 Particularly with the new, more-sensible pack-year threshold, if implemented nationwide, LDCT would save more lives than any cancer-screening test in history. In 2020, the CDC and the ACR recommendations and state/local government requirements caused most imaging facilities to delay non-urgent and elective imaging studies, such as LCS, during the initial phase of the COVID-19 pandemic. A recent consensus paper acknowledges that postponement of LCS and follow-up CT exams is appropriate during the height of the COVID-19 pandemic.3
Unfortunately, cancer incidence does not stop with the pandemic. For some patients, decreased screening now will delay diagnosis and/or increase cancer burden and
worsen outcomes. In practice, the risk of potential complications from COVID-19 infection must be balanced with the patient’s underlying health and lung cancer risk. Over the summer, the ACR LCS 2.0 Steering Committee, led by Debra S. Dyer, MD, FACR, quickly collaborated to create the Resumption of Screening Toolkit, a dedicated resource to assist LCS centers return to screening during the pandemic. This toolkit (available at acr.org/lcs) includes:
- A guide informing patients and providers about the changes made to screening procedures/sites during the pandemic.
- A quick reference for telehealth guidelines and resources for shared decision-making.
- Template letters informing patients and referring providers of updated procedures and precautions due to COVID-19.
As we adjust to the changing state of the pandemic, we must reach out to our referring providers about the status of LCS at our facilities. We must encourage them to prioritize the return of those patients with a previous abnormal LCS result for their recommended short-term follow-up exam, followed by those with a previous negative LCS result who may be overdue for their annual exam. For those patients required by Medicare to undergo a shared decision-making visit prior to their initial LCS, that service can now be provided as a fully reimbursable telehealth visit for the duration of the pandemic.
Although LCS is classified as an elective service, it is also time-sensitive. We know that early detection saves lives. These times are unprecedented, but we are committed to the health and wellness of our patients always.