Implementing an LCS Program
All major medical organizations, including the United States Preventive Services Task Force (USPSTF) and the Centers for Medicare & Medicaid Services (CMS), recommend annual LCS for individuals at high-risk of developing lung cancer, with only one exception.1-9 There is near uniform consensus among these organizations that LCS is appropriate for the population studied in the National Lung Screening Trial (NLST), which enrolled healthy adults who were current and former (quit < 15 years) cigarette smokers aged 55-74 with at least a 30 pack-year smoking history. Many of these organizations including the USPSTF, CMS, American Association for Thoracic Surgery (AATS), and the American College of Chest Physicians (ACCP) now recommend expanding LCS coverage beyond the NLST criteria to capture others at high-risk of developing lung cancer (Organizational LCS Eligibility Recommendations).
Organizational LCS Eligibility Recommendations
Year | Age | Pack-Years | Quit | Other | |
---|---|---|---|---|---|
AAFP1 | 2013 | Ins. Ev. | Ins. Ev. | Ins. Ev. | None |
AATS Tier 12 | 2012 | 55 - 79 | ≥ 30 | No Limit | None |
AATS Tier 22 | 2012 | 50-79 | Over 20 | No Limit | Cumulative 5% chance of developing lung cancer in next 5 years |
AATS Tier 32 | 2012 | Any | Any or None | No Limit | Personal History of Lung Cancer and 4 years NED |
ACS3 | 2013 | Over 50 | ≥ 30 | ≤ 15 | “Relatively good health” |
ACCP4 | 2017 | 55 - 77 | ≥ 30 | ≤ 15 | None |
ALA5 | 2017 | 55 - 80 | ≥ 30 | ≤ 15* | None |
ASCO/ATS6 | 2015 | 55-74 | ≥ 30 | ≤ 15 | None |
CMS9 | 2015 | 55 - 77 | ≥ 30 | ≤ 15 | None |
NCCN Group 17 | 2017 | 55 - 74 | ≥ 30 | ≤ 15 | None |
NCCN Group 27 | 2017 | Over 50 | Over 20 | No Limit | At least one additional lung cancer risk factor or at least 1.3% chance of lung cancer diagnosis within 6 years |
USPSTF8 | 2014 | 55 - 80 | ≥ 30 | ≤ 15 | None |
AAFP = American Association of Family Physicians, AATS = American Association of Thoracic Surgery, ACS = American Cancer Society, ACCP = American College of Chest Physicians, ASCO = American Society of Clinical Oncology, ATS = American Thoracic Society, ALA = American Lung Association, CCO = Cancer Care Ontario, NCCN = National Comprehensive Cancer Network, USPSTF = United States Preventive Services Task Force, CMS = Center for Medicare and Medicaid Services
Year = year recommendation was published, Ins. Ev. = insufficient evidence to recommend for or against screening
Other = additional considerations for groups to screen beyond the core recommendation:
ALA – urges consideration of risk prediction, suggests standard criteria given insurance coverage,
* = not forced to exit screening after reaching 15 year quit mark
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Organizational LCS Eligibility Recommendations
Recommendations of ATS/ACCP policy statements on implementation of LCS
In addition to these clinical practice guidelines, the ACCP and American Thoracic Society (ATS) have issued policy statements to ensure that benefits of LCS outweigh harms as LCS advances from the clinical trial setting to implementation in real-world practice. Multiple other LCS implementation guidelines are available.7,10–12
Core LCS domain13 |
Policy recommendations & metrics for high-quality LCS programs13 |
Implementation strategies6 |
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Who is screened, how often, and for how long?
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Policy recommendation:
Associated quality metrics
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How the CT is performed
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Policy recommendations
Associated quality metric:
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Structured reporting
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Policy recommendations
Associated quality metrics
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Lung nodule management algorithms
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Policy recommendations: LCS programs must:
Associated quality metrics:
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Smoking Cessation
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Policy recommendations
Associated quality metrics
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Patient and provider education
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Policy recommendations
Associated quality metrics
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Provider education:
Patient education / shared decision-making:
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Data Collection
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Policy recommendations
Associated quality metrics
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Recommendations of ATS/ACCP policy statements on implementation of LCS