Community-Based CT Lung Cancer Screening Program Feasible

February 27, 2014

Low-dose CT community-based lung cancer screening program effective and feasible.

A community-based lung cancer screening program is feasible and reasonably quick to set up, according to an article published in the Journal of the American College of Radiology.

Researchers sought to determine the effectiveness of a comprehensive community-based screening and smoking cessation program, and Elkhart, Ind., provided an opportunity to examine such a program. The town has a 23.4 percent smoking rate - compared with the state’s 17 percent - and data shows that over the past decade 50 percent of the lung cancers among the area’s residents were diagnosed at stage IV.

Financially, lung cancer screening programs are generally less expensive (less than $19,000 per life saved) than other cancer screening programs, such as breast cancer screening by mammography ($31,000 to $51,000 per life saved) and colorectal screening ($19,000 to $29,000 per life saved).

The researchers set up a multidisciplinary team of medical staff that assessed diagnostic examinations and provided management. The team also included a social worker, registered dietician, clinical trials nurse, smoking cessation counselor, and a lung nurse navigator. Patients who met the high-risk criteria established by the National Lung Screening Trial (NLST) were recommended to undergo low-dose CT (LDCT). The screening aspect was designed to follow the patients for several years.

“A smooth, seamless process from initial screening CT to appropriate follow-up, and treatment when indicated, was critical to ensuring the success of the screening portion of the program,” the authors wrote.

Patient risk was assessed by questionnaire, based on age, pack-year history, and current and former smoking status. For patients who did not have insurance or for whom out-of-pocket expenses were not affordable, the administrators and radiologists worked to find the most cost-effective methods. A grant was also secured from the hospital foundation to cover scans for those who were unable to afford the tests.

Because the frequency of the CT screening (yearly or more frequent) was an issue, dose optimization resulted in the LDCT scan being completed at half the dose reported in the NLST.

The patients were contacted by phone five days following the scan to discuss the results, book the next appointment (at either three, six, or 12 months), and plan follow-up, if necessary. Patients who still smoked were offered appointments for smoking cessation counseling. Scan results were also sent to any physicians the patient requested.

The results after 150 LDCT screening performed over 13 months showed that:

  • 100 patients (67 percent) were given appointments for a 12-month follow-up
  • 28 patients (19 percent) were to return in six months
  • 11 patients (7 percent) were to return in three months
  • 2 patients (1 percent) were recommended to have biopsies and one was diagnosed with cancer

When this screening program was compared with the NLSC, the researchers noted that 27 percent of the community-screening program’s scan interpretations were recommendations for follow-ups within 12 months, while 39 percent of NLSC participants had at least one follow-up within 12 months.

In addition, the format for reporting the LDCT results, the Lung Reporting and Data System (L-RADS), provided uniformity in the reports, which the practicing physicians found useful when discussing the recommended follow-ups.

There are plans to promote and track smoking cessation among this population. The authors concluded that this type of community screening program is possible and can be implemented with a one- to two-year planning period.