Shared Decision-Making Resources

Key elements for a five-minute discussion between provider and patient regarding LCS

Key elements for a five-minute discussion between provider and patient regarding LCS

Healthcare experts recommend LCS for individuals at high-risk for developing lung cancer. The goal of LCS is to detect lung cancer early to save lives. Without LCS, lung cancer is usually not found until a person develops symptoms, and at that time, it is more difficult to treat. LCS is performed using a lower radiation version of a chest CT scan, taking an image of your lungs and surrounding structures. This is a 10-minute test that is performed as an outpatient.

Eligibility criteria:

  • As a Medicare or Medicaid patient, you are eligible for LCS if you are age 55 to 77, have smoked the equivalent of one pack of cigarettes per day for at least 30 years, and are a current smoker or quit smoking within the past 15 years.
  • As a private health insurance patient, you are eligible for LCS if you are age 55 to 80, have smoked the equivalent of one pack of cigarettes per day for at least 30 years, and are a current smoker or quit smoking within the past 15 years.
  • It is important that you have no signs or symptoms of lung cancer including persistent cough, worsening of chronic cough, coughing up blood, constant chest pain, persistent hoarseness or unintentional weight loss of greater than 10 percent of baseline weight. If you have any of these symptoms, then a different type of diagnostic evaluation is required.

Potential benefits:

  • The major benefit of LCS is preventing death from lung cancer.
  • A large national study called the National Lung Screening Trial has shown that LCS with a low-dose CT scan can decrease lung cancer deaths by 20 percent in high-risk individuals. In other words, CT screening resulted in three fewer lung cancer deaths for every 1,000 individuals screened.
  • CT screening for lung cancer is at least as effective in preventing lung cancer deaths in high-risk individuals as mammography is in preventing breast cancer deaths and colonoscopy is in preventing colon cancer deaths.
  • If you are concerned about the possibility of having lung cancer, a normal screening CT scan can be reassuring.

Potential harms:

There are several potential harms to a screening that you should consider:

Radiation risk:
  • The screening CT scan will expose you to a low level of radiation, equivalent to six months of background radiation exposure or 50 coast-to-coast round-trip flights in a commercial airplane.
  • This is considered a very low risk.
Anxiety risk:
  • One in four patients may have a lung nodule or “spot” found on screening CT. The number of false positive findings or “false alarms” outnumber cancers by 25 to one.
  • One in 10 patients may have an abnormality other than a lung nodule(s) found on the scan that is not causing any symptoms but may require evaluation.
Complication risk:
  • Sometimes a finding on the screening CT leads to the need for additional testing such as a biopsy or surgery that can cause harm in individuals that do not have cancer.
  • The risk for a major complication from invasive procedures is three for every 1,000 individuals undergoing such additional testing.
Overdiagnosis risk:
  • There is a possibility that a lung cancer could be diagnosed by screening that would never cause a problem because it is very slow growing.
  • One in 10 lung cancers found by CT screening will never cause a problem for the patient.

Cost:

  • As an eligible Medicare or Medicaid patient, the screening CT scan will not cost you anything out of pocket.
  • As an eligible private health insurance patient, the screening CT scan will not cost you anything out of pocket nor be charged to your deductible.

Screening Modality:

  • The 20 percent decrease in lung cancer deaths found in the large national study was through screening with low-dose CT scan.
  • A separate large national study showed that routine chest x-ray is of no benefit for LCS.

Patient Commitment:

  • Like mammography, LCS is not a one-time test. You should be willing to undergo yearly screening as long as you continue to meet the eligibility requirements.
  • In addition, you should be willing to undergo surgery to treat an early stage lung cancer detected by screening.

Smoking Cessation:

  • Smoking cessation remains the most effective way to prevent lung cancer as a current smoker, we want to help you quit smoking for good.
  • CT screening for lung cancer is most effective in decreasing your risk of death from lung cancer when combined with smoking cessation.

Clinical Decision Support Tools

Decision Aid
Source
Media
Individualized risk assessment
Criteria for positive scan
Link
Should I Screen
University of Michigan
Web - Interactive
Yes
NLST
LCS with Computerized Tomography (CT)
American Thoracic Society
Print
No
NLST
LCS Benefits, harms of chest CT scans
Health Decision
Web – Interactive
Yes
NLST
Lung Cancer: Should I Have Screening?
Healthwise
Web – Interactive and print
No
NLST
LCS: Yes or No
Options Grid - Dartmouth Institute
Web interactive and print
No
Lung- RADSTM
LCS
Center for Clinical Management Research, Ann Arbor VHA
Web- interactive
Yes
NLST
Lung cancer Project
Genentech
Web – Interactive and print
No
NLST & Lung- RADS™
LCS Saves Lives
American Lung Association
Web – Interactive and print
No
NLST
Click to View Table:

Clinical Decision Support Tools

National Organizations and Websites

American Heart Association

Toll-free number: 1-800-242-8721 (1-800-AHA-USA-1)
Website: www.americanheart.org
Quitting tips and advice can be found at www.everydaychoices.org or by calling.
1-866-399-6789.

American Lung Association

Toll-free number: 1-800-LUNGUSA
Website: www.lung.org
Printed quit materials are available, including Spanish materials. Also offers an online quit smoking program Freedom From Smoking® Plus at www.FreedomFromSmoking.org; in-person group clinics at www.lung.org/ffs and telephonic services at 1-800-LUNGUSA.

Centers for Disease Control and Prevention Office on Smoking and Health

Free quit support line: 1-800-784-8669 (1-800-QUIT-NOW)
TTY: 1-800-332-8615
Website: www.cdc.gov/tobacco
The quit support line offers information on smoking and health as well as help with quitting. Languages and range of services vary by your state of residence.

Environmental Protection Agency (EPA)

Telephone: 202-272-0167
Website: www.epa.gov
Has advice on how to protect children from secondhand smoke at 1-866-766-5337 (1-866-SMOKE-FREE).

National Cancer Institute

Free tobacco line: 1-877-448-7848 (1-877-44U-QUIT) (also in Spanish)
Direct tobacco website: www.smokefree.gov
Quitting information, quit-smoking guide, and counseling are offered, as well as referral to state telephone-based quit programs (if needed for special services).

Nicotine Anonymous (NicA)

Toll-free number: 1-877-879-6422 (1-877-TRY-NICA)
Website: www.nicotine-anonymous.org
For free information on their 12-step program, meeting schedules and locations, print materials, or information on how to start a group in your area.

QuitNet

Website: www.quitnet.com
Offers free, cutting-edge services to people trying to quit tobacco.

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