News Headline: Lung Cancer: CT Screening Ready, Patients Not So Much
Outlet Full Name: MedPage
Author: Ed Susman
CHICAGO – Most of the leading academic centers are operating CT-based lung cancer screening programs – and embedded in that screening is a smoking cessation program, researchers reported here.
Of the 21 leading academic centers identified by US News and World Report, 19 responded to a survey regarding screening programs and 15 institutions said they already had programs up and running, said Phillip Boiselle, MD, professor of radiology at Beth Israel Deaconess Medical Center/Harvard Medical School, Boston.
Eleven of those 15 programs offer optional smoking cessation courses, and three more make the smoking cessation course mandatory for individuals undergoing lung cancer screening, he reported at the annual meeting of the Radiological Society of North America. One of the centers did not include a smoking cessation program.
“Most leading academic medical centers had an active screening program in March 2013 when the survey was conducted,” Boiselle said, “but few patients were being screened.”
Boiselle and colleagues sought to determine how the recommendations of the National Lung Screening Trial – specifically that CT screening be conducted at academic institutions – were being implemented in practice, especially in light of varying recommendations on screening by several national organizations.
He did not identify the medical centers that responded to the survey.
Among the findings:
- 11 centers used National Lung Screening Trial criteria for performing the CT scans; one used the expanded criteria of the National Comprehensive Cancer Network; three used shared decision making criteria which offered input on screening from both patients and physicians.
- 11 centers required clinical referrals to undergo the screening.
- 10 centers charged between $300 and $400 for a screening test; one center charged more than $400; three charged between $150 and $300; and one charged $150 or less for the procedure.
- Seven used doses in the 1-2 mSv range; five used doses less than 1 mSv; three used radiation doses above 2 mSv. The recommended dose is about 1.4 mSv.
- Two hospitals used computer-assisted diagnostics in their screening program, but 13 of the centers did not.
Boiselle said the survey preceded national recommendations for lung screening, so his figures might be conservative. He also noted that there might be local and community hospitals not listed by US News & World Report that are doing screening and are not accounted for in his analysis.
“The surprising result of the survey is the magnitude – or rather the lack of magnitude – of uptake of the screening programs,” said Alexander Bankier, MD, PhD, professor of medicine at Harvard Medical School, and co-moderator of the oral presentation session.
In response, Boiselle said, “We did hear from a number of the institutions that ‘we have everything set up, we just don’t have any patients.’ There appears to be a disconnect between the level of planning for the screening and the number of patients.”
In commenting on the study from the audience, Daniel Berman, MD, professor of medicine at the University of California, Los Angeles Cedars-Sinai Medical Center, “The number of cancer deaths and cardiovascular deaths that could be saved by increasing screening programs is staggering.” He suggested that increasing self-referral as has happened with calcium screening in cardiovascular disease could increase the number of patients for lung screening, and lower the cost of the scans as well.