Lung Association’s Cancer CT Screening Recs a Good Start

Recent recommendations for lung cancer CT screening from the American Lung Association (ALA) are expected to improve early detection of the disease. They’ll also likely increase your work flow and could change the way insurance providers pay for screenings.

Released on Monday, the ALA guidelines call for CT screening for all current and former smokers from ages 55 to 74 who have smoked a pack of cigarettes a day for at least 30 years. This formal push could lead to additional organizations joining the chorus, calling for improved diagnostic services.

“Hopefully, this recommendation will lead to more encouragement for us to get lung cancer screening approved through third-party payers,” said Reginald Munden, MD, radiology professor with M.D. Anderson Cancer Center. “The ALA has a high profile, so it is one of the organizations that will increase the odds of that happening.”

Although a final cost effectiveness analysis is still forthcoming, Munden posited this pressure could prompt insurance providers to approve funding for lung cancer screenings.

The ALA’s clinical suggestion is rooted in the findings from the National Cancer Institute National Lung Cancer Screening Trial (NLST). The study demonstrated CT screening can detect pre-symptomatic lung cancer in high-risk populations and reduce associated deaths by 20 percent compared to chest X-ray.

ALA chief medical officer Norman H. Edelman, MD, acknowledged the bar for patients to be screened is high, but said current research only supports applying the recommendation to this group.

“There’s always a risk with everything that we do. There’s a risk of unneeded lung biopsies or excessive radiation. All we can do at this time is look at the best data to make a screening recommendation for the 55-to-74-year-old long-term smoking populations,” he said. “We’re not saying yea or nay about other populations – just that there’s not enough scientific evidence to make any recommendations at this time.”

In addition to supporting the use of CT screening in this population, the ALA also recommended providers only conduct screenings in a low-dose CT machine. It’s also important, Edelman said, to run the studies in multidisciplinary centers that offer a variety of care modalities to patients. When a screening identifies a nodule, many types of providers join the care team, and having them in one location is a convenience to the patient.

Impacting Your Work Flow

Although these recommendations are likely to push more patients to come in for CT screening, the impact it has on your day-to-day activities will likely be minimal, Munden said. Scheduling more staff during certain days should mitigate any problems because preparing a patient for this type of study is relatively simple.

However, in the long term, he said, the industry should consider developing an overarching clinical policy for lung cancer screening similar to what exists for mammography.

“My hope is we can do this with a programmatic method like what we do with mammography,” he said. “The number of screening exams you’d do would never approach the same number, but it could be set up for a more self-contained clinical experience along with smoking cessation material.”

Unless providers mesh patient education with the studies, lung cancer screening won’t reach its full potential as a diagnostic service that can improve care and patient outcomes, he said.

“I consider lung cancer screening to be in the infancy phase when compared to more mature programs. We now have to go out and prove who this will work best in – 55 years and a 30-pack history is a high entry level for screening,” Munden said. “We must find out if this will also work with people with less risk. But for the time being low-dose CT screening is the best we can do."