There is an ever-growing body of evidence that lung cancer screening (LCS) with low-dose CT (LDCT) is effective. Most in the medical community were delighted when the results of the National Lung Screening Trial in 2011 showed a 20% reduction in lung cancer mortality with LDCT and with the subsequent Grade B recommendation from the U.S. Preventive Services Task Force. This milestone led to insurance and Medicare coverage for LDCT as a preventative service in eligible patients — which meant eligible patients could receive LDCT with no cost sharing or co-pay required.
Unfortunately, the uptake of LDCT has been disappointingly low — likely due to the complex eligibility requirements and multiple barriers to access. Social factors, including stigma related to smoking, also discourage patients from seeking screening services. While these are significant challenges, they also represent an opportunity for LCS advocates, and in particular radiologists, to step up and make a difference. We have an effective screening tool that can save lives but it is not being utilized. We can and must identify strategies to increase the adoption of LCS to decrease the burden of lung cancer on society.
I have had the opportunity to serve as chair of the ACR LCS 2.0 Steering Committee over the past year. With strong support from ACR leadership, the Committee was formed to evaluate and address the barriers to LCS and empower radiologists, along with other stakeholders, to increase the adoption of LCS. Members were recruited from a wide variety of practice environments, including academic, government, and community-based practices from across the country and from metropolitan, suburban, and rural areas. The Committee was designed to be inclusive and diverse and continues to welcome any interested members. The members bring a wealth of experience and share best practices to inform our work. With the help of the amazing ACR staff, our Committee has reached several milestones.
Four workgroups have been formed that focus on specific issues or barriers to LCS: economic/billing issues, community-based LCS, outreach to patients and providers, and clinical resources and incidental findings. The workgroups have addressed numerous topics and created two important quick guides — easy-to-understand reference documents for LCS programs. The guides are focused on economic/billing issues in LCS and managing incidental findings on LDCT, and are based on the valuable ACR white papers on incidental findings. The quick guides are intended for use by LCS program coordinators, nurse navigators, and referring providers, but will also be useful to practicing radiologists.
At ACR 2019, the Committee presented a boot camp on LCS, which was so successful that it was presented again as a webinar series in July and August. The topics included economic issues, program logistics, quality metrics, disparities, Lung-RADS®, and how to build and lead a LCS program. Another webinar series is being planned for the coming year.
Collaboration and engagement with other LCS stakeholders has been another important accomplishment of the Committee. The group has established strong ties with the American Cancer Society’s National Lung Cancer Roundtable (NLCRT) and a number of the LCS 2.0 Committee members serve on the NLCRT committees.The Committee has worked closely with multiple other organizations, including the GO2 Foundation for Lung Cancer (formerly the Lung Cancer Alliance and the Bonnie Addario Foundation), several state health departments, various cancer coalitions, and (of course) patients who share their stories and guide our efforts.
The Committee has certainly benefited from the extensive experience of the ACR in other screening programs such as mammography. Our colleagues in breast imaging have provided models of how to set up screening programs, how to interact directly with patients, how to manage quality metrics, how to influence payment policy, and how to manage misinformation in the media.
As we acknowledge our accomplishments, we know there are ongoing challenges. We need to help patients navigate our complex and often fragmented healthcare system. We need to address the high-deductible health insurance plans that often hinder patients in getting timely diagnostic follow-up care. We need to find ways to make the shared decision-making requirement less onerous and explore novel approaches. We must do all we can to increase access to LCS services — while ensuring high-quality appropriate care. I am confident we will continue to make progress, together.