lung cancer screening is a n essential part of early diagnosis and treatment of lung cancer

1. An Update on Status
OF
Lung Cancer Screening
BY
DR, ANIMESH ARYA
MD DTCD FIACM RPSGT
SR. CONSULTANT PULMONOLOGIST AND HEAD OF DEPTT. OF
PULMONARY MEDICINE
SHRI BALAJI MEDICAL IONSTITUTE
AND
ACTION CANCER HOSPITAL
NEW DELHI

2. LUNG CANCER FACTS
• LUNG CANCER IS ONE OF THE MOST FREQUENT CANCERS
• WORLDWIDE THE LEADING CAUSE OF CANCER DEATH.
• 2.2 MILLION GLOBAL NEW LUNG CANCER CASES WEREDIAGNOSED IN
2020 AND THAT 1.8 MILLION CANCER DEATHS WERE CAUSEDBY LUNG
CANCER, ALMOST ONE FIFTH OF ALL CANCER DEATHS.
The mortality is more than breast colon and prostate cancers combined
MEN 23 TIMES
WOMEN 13 TIMES AT RISK FOR SMOKERS VS. NON SMOKERS
In west 80 percent more than 60 years but in ASIA THINGS ARE DIFFERENT

3. CONTD.
• POOR PROGNOSIS
• 5 YR SURVIVAL LESS THAN 10-18 PERCENT
• HALF DIE WITHIN ONE YEAR OF DIAGNOSIS
• STAGE 1 SURVIVAL > 90PERCENT
HENCE THE NEED FOR EARLY DIAGNOIS
Most patients diagnosed
with advanced disease

4. Lung Cancer Facts
•Lung cancer is curable when diagnosed early
Journal of Thoracic Oncology 2017 12: 1109-1121

5. Let’s begin with a case…
• A 60-year-old female presents for a periodic health examination. She
asks, “Doc, should I get that lung screening test? I’ve been smoking
for 40 years.”
• What do you recommend?
5

6. • CXR
• CTSCANCHEST

7. SCREENING IS MOST
IMPORTANT TOOL TO
IMPROVE THE OUTCOME

8. Stakeholders in medical community for
Lung Cancer Screening Program
• Specialized Lung Cancer Team with expertise in lung cancer and lung
cancer screening
• Thoracic surgeons
• Medical oncologists
• Radiation oncologists
• Chest radiologists
• Interventional pulmonologists
• Pulmonary pathologists
• Oncology nurses and nurse practitioners
• Molecular scientists

9. Lung Cancer Screening
• What is screening?
• A test done to detect a cancer before symptoms develop
• Symptoms of lung cancer typically do not appear until the disease is advanced
• Why hasn’t lung cancer screening been routine?
• Until recently, there hasn’t been an effective test
• Lung cancer screening with CXR showed no benefit
• No change in lung cancer deaths

10. What is the Benefit of Screening?
• Detection of lung cancer early when it is curable
• Decreased chance of dying from lung cancer
• 7 million Americans estimated to be eligible for lung cancer screening
• Could potentially save 22,000 lives
• Estimated that <4% have undergone screening!

11. Who Should Get Screened?
• Age 55-80
• Current or former smoker
• >20 pack year smoking history
• Packs per day X years smoked
• 1 pack per day for 20 years or 2 packs per day for 10 years
• No symptoms of lung cancer
• New or changing cough
• Coughing up blood
• New or increasing shortness of breath

12. The National Lung Screening Trial
Main findings
published in 2011.
Randomized >53,000
heavy smokers to…
• Low-dose
computed
tomography
(LDCT) or chest x-
ray
• 3 annual screens
• Followed 6.5 years
14
NLST Research Team, NEJM 2011; Bach, Jama 2012; Pinsky, Cancer, 2014.
NNS = 320
Reduced lung cancer deaths
by 16-20%.
A game changer!

13. National Lung Screening Trial
• People who got low-dose CT scans had a 20% decreased risk of dying
from lung cancer
• 320 people need to be screened to prevent 1 lung cancer death
• 1339 for breast cancer
• More cancers detected at an early stage
• First time that lung cancer screening has been shown to decrease lung
cancer deaths!
• Results announced in 2010-11
New England Journal of Medicine August 4th, 2011

14. What to Expect
• Low-dose CT
• No IV or dye used
• Scan completed in under a minute

15. What do the Results Mean?
• Negative screen
• No nodules (spots) seen and no other abnormalities
• Annual low-dose CT scan
• Positive screen indeterminate for lung cancer
• A nodule (spot) was seen
• About 50% of patients will have at least one nodule
• Most of these spots are NOT cancer
• Positive screen suspicious for lung cancer
• Further testing or biopsy may be recommended

16. What are the Risks?
• False positives
• Finding a nodule (spot) that is not cancer
• Most nodules (95%) seen on CT are not cancer
• May require additional testing
• False negatives
• A negative screening CT does not mean you don’t have lung cancer or can’t get
lung cancer

17. What are the Risks?
• Radiation exposure
• Low-dose CT ~ 20-25% of standard CT
• Similar to 12 CXRs
• Similar to 6 months of natural background radiation
• Costs
• Most insurance companies cover lung cancer screening
• There may be cost for additional CT scans and testing for positive results

20. What do the Results Mean?

21. What do the Results Mean?
• What if I have a nodule (spot)?
• We may recommend:
• Follow up scan in 3-6 months
• Further testing such as a PET scan
• Referral to a lung specialist for possible biopsy

26. O’Dowd EL, Baldwin DR. Lung nodules: sorting the wheat from the chaff. Br J Radiol (2023) 10.1259/bjr.20220963.
INCIDENTAL IMAGING FINDINGS FROM HEAD TO TOE: CHALLENGES AND MANAGEMENT: CARDIOTHORACIC: REVIEW ARTICLES
Lung nodules: sorting the wheat from the chaff
EMMA L O’DOWD, FRCP, PhD and DAVID R BALDWIN, FRCP, MD
Department of Respiratory Medicine, David Evans Building, Nottingham City Hospital, Nottingham, United Kingdom
Address correspondence to: Emma L O’Dowd
E-mail: emma.odowd@nottingham.ac.uk
ABSTRACT:
Pulmonarynodulesare a common findingon CT scansof thechest. IntheUnitedKingdom,management shouldfollow British Thoracic Society Guidelines, which were published in 2015.This review covers key aspects of nodule manage- ment also looks at new and emerging evidence since then.
INTRODUCTION
The number of CT scans performed in the United Kingdom (UK) is increasing year on year. Data from the Diagnostic Imaging Dataset (DID) for England showed
that 679,015 CT scans of the chest and/or abdomen were performed in England between March 2021 and March 2022, a 6% increase from the preceding 12 months.1
Pulmonary nodules are a common incidental finding. They have a prevalence of 13% (range 2–24%) in non- screening populations, which rises to 33% in those
undergoing lung cancer screening (range 17–53%).2
More than 50% of patients with a pulmonary nodule have more than one nodule.3
A review of published
data for the British Thoracic Society (BTS) guideline showed that lung cancer prevalence was similar for nodules detected across both groups at 1.5% (incidental)
and 1.4% (screening).2
A recent study from the United States examined nodules detected via screening and those from an incidental nodule management pathway.
The authors showed a lung cancer detection rate of 2.7 and 4.9% respectively.4
Importantly, many of the incidental nodule detection group would not have been eligible for
screening but both groups had favourable outcomes.
Management of pulmonary nodules, whether detected by screening or incidentally, aims to maximise early detection of malignancy while minimising harms (and cost) from
overinvestigation. This is particularly important given the recent positive recommendation from the United Kingdom National Screening Committee regarding screening for lung
cancer with low-dose CT (LDCT) in September 2022. This paper covers some key aspects of the management
of pulmonary nodules and considers new or emerging evidence since the publication of the BTS Guidelines in 2015.2

27. Lung nodules BJR
widely used in United States lung cancer screening programs
and also adopted in several other countries that are running
screening pilots. In the latest update, volumetry thresholds are
31 of 7
birpublications.org/bjr
provided but these are calculated directly from diameter thresh-
olds. Additional time for volumetry is not reimbursed in the
United States.
Table 1. Summary of key recommendations from Fleischner Society and British Thoracic Society guidelines for management of
incidentally detected nodules
Fleischner Society 2017 British Thoracic Society 2015
Scope Incidentally detected nodules only All nodules regardless of presentation route
Age ≥35 years ≥18 years
Solid nodules
Volumetry or diameter preferred Average diameter rounded to the nearest whole millimetre.
(Volumetry threshold also provided)
Volumetry.
Maximum diameter if volumetry not possible/ unreliable
Threshold for follow-up 6mm 80 mm3
or 5mm
Initial management recommendation Variable depending on nodule size and number:
• 6–8mm (100–250mm3
)
◦ Single nodule- CT at 6–12 months
◦ Multiple nodules- CT at 3–6months
• > 8mm (>250 mm3
)
◦ CT at 3months/ PET CT or biopsy
Based on nodule size:
• 80–300mm3
(5–8mm)
◦ CT at 3months
• 5–6mm (no volumetry available) CT at 12months
• >300 mm3
(>8mm)
◦ Risk assessment with Brock score
◦ ≥ 10%PET CT, followed by Herder score (<10% CT at 3 months; 10–70%— consider
image-guided biopsy, excision or surveillance; >70%consider definitive treatment).
◦ < 10%CT at 3months
Definition of growth ≥2 mm diameter >25%increase in volume (volumetry or diameter measures where volumes not available)
Clear visual evidence of growth
Duration of follow-up for stable nodules Variable depending on nodule size and features:
• 12–18 months if benign features and “unequivocally stable”
• 18–24months if high risk or multiple
Volumetry:
• 12months Diameter:
• 24months
Can also consider discharge if VDT > 600days
Subsolid nodules
Volumetry or diameter preferred Average diameter for entire nodule; maximum diameter for the solid component Diameter
Threshold for follow-up Depends on nodule number:
• Single nodule—6mm
• Multiple nodules—no lower size threshold
5mm
Initial management recommendation Variable depending on nodule size, number and GGN or PSN
• Multiple nodules/ <6mm but high risk population (e.g. Asian):
◦ CT at 3–6months
• ≥6mm
◦ Single GGN—CT at 6–12 months
◦ Single PSN—CT at 3–6 months
◦ Multiple (GGN &PSN)—CT at 3–6 months
CT scan at 3months
Management recommendation/ surveillance interval for
persisting nodules
• < 6mm
◦ CT at 2 and 4years (GGN &PSN)
• ≥ 6mm (≥100mm3)
◦ Single GGN—CT every 2years
◦ Single PSN—CT every 1year
◦ Multiple (GGN & PSN)—depends on most suspicious nodule
• Risk assessment with Brock score
◦ Low risk (<10%)—CT at 1year, 2years and 4years
◦ High risk (> 10%) or concerning morphology (solid component presence or growth,
pleural indentation, vacuolation)— consider image-guided biopsy, excision, non-surgical
treatment or surveillance
Duration of follow-up for stable nodules • Single nodule—5years
• Multiple nodules— guided by largest nodule
• 4years
GGN, ground-glass nodules;PET, Positron emission tomography; PSN, part-solid nodule;VDT, volume doubling
time.

28. THRESHOLDS FORACTION ACCORDING TO CURRENT GUIDELINES
ACTION BTS Lung RADS ®
v. 1.1/NCCN
European Position
Statement
(Volumetry preferred)
I-ELCAP
Annual screen N/A
<4 mm
<34 mm3 <4 mm
<30 mm3
<3 mm
Extra CT N/A
4 to 10 mm
(PET-CT option if > 8
mm) (≥ 268 mm3
)
4–8 mm
≥100 to <200 mm3 >3 mm
(>3 mm to 5.9 mm, 6 month CT
>6 mm to 14.9 mm, 1 month CT)
Work-up suggested N/A
≥10 mm (≥524
mm3
)
(PET-CT option if > 8
mm) (≥268 mm3
)
≥ 8 mm
≥200 mm3
>15 mm
Comparison of the key nodule guidelines regarding
incident solid nodules and suggested management in
screening

29. Brock Model Herder Model
Patient characteristics Age Age
Gender Smoking status
Family history of lung
cancer
Personal history of
extrathoracic cancer
Emphysema
Nodule characteristics
Nodule size (diameter in
mm)
Nodule size (diameter in
mm)
Nodule count
Nodule in upper lobe
Nodule type Spiculation
Nodule in upper lobe Nodule in upper lobe
PET-CT avidity findings
Spiculation Spiculation
Brock and Herder Model variables

31. BJR O’Dowd and Baldwin
ARTIFICIAL INTELLIGENCE AND COMPUTER
AIDED DETECTION
There is great interest in using machine learning techniques to
detect and risk stratify pulmonary nodules. Artificial intelligence
(AI)-based nodule prediction solutions have been shown to out-
perform existing multivariable models.33,34
An AI model can
account for nodule size, shape, location and other radiological
factors consistently, without requiring subjective judgement or
data entry on the part of the clinician. Inter-reader variability
in reporting morphology and nodule type is common, even
amongst experienced thoracic radiologists.35
In a study in the
United States, a two-fold difference in recommendations was
observed for the same group of patients following evaluation by
different physicians.36
Several AI/CAD-based models have been developed and vali-
dated in recent years. A research team at Google produced a
deep learning model which performed as well as radiologists in
predicting malignancy in pulmonary nodules.37
Optellum Ltd
have developed and externally validated an AI-based CAD tool
for lung cancer prediction in pulmonary nodules.33,34
This was
shown to outperform the Brock model in terms of discrimina-
tion, and allowed a larger proportion of benign nodules to be
identified without missing cancers.33
This has the potential to
reduce radiology workload by avoiding unnecessary follow-up in
benign nodules and enabling earlier identification of malignant
nodules. It is currently the focus of a multicentre NHS imple-
mentation trial termed “DOLCE” (Determining the impact of
Optellum’s LCP artificial intelligence solution on service utilisa-
tion, health Economics and patient outcomes).38
Furthermore, the ability to systematically train and refine the
model on many thousands of different images with a known
outcome confers AI models with an edge in terms of diagnostic
accuracy over non-AI models.39
Although these AI solutions will
help, a number of challenges remain, including patient selection
bias, accountability and data privacy issues.40,41
A platform to
allow comparison and validation of AI tools is needed to fully
define their role, clinical benefits and cost effectiveness.
SUBSOLID NODULES
Persistent part-solid nodules (PSNs), although less prevalent than
solid nodules, are 1.4–5 times more likely to be malignant than
solid nodules, but they often demonstrate very slow growth.38,39
Several large studies looking at the natural history of SSNs have
been published since the BTS Guideline recommendations were
made. One group followed up over 1200 PSNs and pure ground-
glass nodules (pGGNs or non-solid) and showed that invasive
adenocarcinoma was only seen in pGGN that developed a solid
component. The median time to progression was 3.8 years.42
The I-ELCAP group showed that the median transition time
from non-solid to PSN in pGGNs was 25 months and there
was 100% lung cancer specific survival in this group.43
Longer
term follow-up data from the National Lung Screening Trial
suggest that even PSN have very good outcomes.44
Data from the
Multicenter Italian Lung Detection screening trial also showed
a median time to lung cancer diagnosis of 52 months for SSN,
with no lung cancer deaths attributed to SSN.45
In light of this
evidence, a more conservative approach, particularly for pGGNs
may be appropriate as they are usually slowly growing and may
not influence prognosis. However, in patients who are younger,
it may be appropriate to offer a longer period of surveillance
(beyond the 4years suggested by the current BTS Guideline).
THE PULMONARY NODULE SERVICE
Many NHS hospital Trusts have dedicated pulmonary nodule
multidisciplinary team (MDT) meetings to review incidentally
detected nodules and advise on surveillance intervals. There
is evidence that this improves adherence to guidelines.46
The
nodule MDT may include a respiratory physician, radiologist,
radiographer, co-ordinator and nurse. Many of these are run
as a “virtual” MDT. Patients who have low risk nodules, which
Figure 2. (a) CT scan showing pure ground-glass nodule. (b) Volumetry applied to the nodule in CT image (Figure 2a).
35 of 7
birpublications.org/bjr

32. ADDITIONAL SCREENING
TOOLS
BRONCHOSCOPY
MARKERS
TISSUE MARKERS

33. BRONCHOSCOPY
Bronchoscopy is a common approach to tissue sampling and is frequently used in patients with IPNs and an
intermediate-risk of malignancy, for whom guidelines show heterogeneity in management recommendations
ranging from CT-surveillance to non-surgical biopsy. Bronchoscopy is a relatively safe procedure with less
than 1% of cases complicated by pneumothorax.
29 Approximately 500,000 bronchoscopies are
performed annually in the United States of which approximately half are done for lung cancer
evaluation.
30 Nevertheless, bronchoscopy has lower sensitivity for smaller and peripherally-located
nodules and up to 40% of bronchoscopies lead to a non-diagnostic outcome wherein the clinician cannot
obtain a clinically actionable benign or malignant diagnosis. Physicians are subsequently faced with the
dilemma of whether to monitor such patients with CT surveillance or proceed to a surgical lung biopsy or
transthoracic needle biopsy associated with a greater risk of morbidity, such as pneumothorax or
hemorrhage, or mortality.
31
First Generation Gene Expression Profiling (GEP) Test: Percepta Bronchial Genomic
Classifier (BGC)
Second Generation GEP: Percepta Genomic Sequencing Classifier (GSC)

34. Diagram of the discovery biomarkers stages: I comparison of tumor tissue with nontumor tissue to
identify characteristics unique to the neoplasm, to identify possible biomarkers (e.g., proteins, mRNA,
genes). II. Designing a case–control study to assess whether the biomarker is uniquely expressed in both
tumor tissue and other noninvasive biological samples (e.g., blood) with the aim of distinguishing cancer
patients from healthy subjects. III. Collection of noninvasive samples from cancer patients who have not yet
received a diagnosis and from subjects who have not developed cancer. This aspect could confirm the
biomarker’s ability to detect cancer in a preclinical stage, making it suitable as a screening
test. IV. Individuals who tested positive with biomarkers are referred for further diagnostic evaluation. This
phase also helps to identify the number of false-positive cases undergoing further assessment.

35. Study Population Method Biomarkers Main Results
Xu BJ [11]
40 LC
8 HR
MALDI-MS Proteins 75% accuracy
Doseeva V [13]
75 LC
75 HR
IMMUNOASSAY xMAP Proteins and autoantibody
77% sensitivity
80% specificity
Mazzone PJ [14]
155 LC
245 HR
IMMUNOASSAY MAGPIX Proteins and autoantibody
74% sensitivity
80% specificity
Silvestri GA [15]
29 LC
149 HR
MS Proteins
97% sensitivity
44% specificity
Chapman CJ [17]
235 LC
266 HR
ELISA Autoantibodies 92 % accuracy
Du Q [18]
305 LC
74 HR
ELISA Autoantibodies
56.53% sensitivity
91.60% specificity
Yu L [24]
64 LC
58 HR
qRT-PCR miRNA
80.6% sensitivity
91.7% specificity
Montani F [27]
74 LC
115 HR
NA miRNA
77.8% sensitivity
74.8% specificity
Sozzi G [29]
69 LC
870 HR
PCR miRNA
87% sensitivity
81% specificity
Yu Y [32]
153 LC
93 H
RT-PCR + FISH CTCs
67.2% sensitivity for stage I
84.1% specificity
Katz RL [33]
107 LC
100 H
FISH CTCs
89% sensitivity
100% specificity
Newman AM [36]
13LC
13 H
CAPP-Seq ctDNA 96% specificity
Ponomaryova AA [38]
60 LC
32 H
TaqMan PCR (MSP) cirDNA
87% sensitivity
75% specificity
Rudnicka J [42]
86 LC
41 H
GC/MS VOCs
80% sensitivity
91.23% specificity
Shlomi D [45]
89 LC
30 H
eNOSE VOCS
83% accuracy
79% sensitivity
85% specificity
McWilliams A [46]
25 LC
166 H
eNOSE VOCs 80% accuracy
Gasparri R [47]
70 LC
76 H
eNOSE VOCs
81% sensitivity
91% specificity
Hanai Y [49]
20 LC
20 H
GC/MS VOCs
95% sensitivity
70–100% specificity
Gasparri R [50]
46 LC
81 H
GC/MS VOCs
85% sensitivity
90% specificity
Table 1
Selected lung cancer biomarkers.
LC = lung cancer patients; H = healthy subjects.

37. HOW IS IN ASIA OR INDIA

38. Lung Cancer Screening in Asia: An Expert Consensus Report
David Chi-Leung Lam, MD, PhD, Chong-Kin Liam, FRCP, Sita Andarini, MD, PhD, Samina Park, MD,
Daniel S.W. Tan, PhD, Navneet Singh, MD, DM, FRCP, Seung Hun Jang, MD, PhD, Varut
Vardhanabhuti, PhD, Antonio B. Ramos, MD, Tomio Nakayama, MD, PhD, Nguyen Viet Nhung, MD,
PhD, Kazuto Ashizawa, MD, Yeun-Chung Chang, MD, PhD, Jamsak Tscheikuna, MD, Cong Cung Van
PhD, Wai Yee Chan, MD, Yeur-Hur Lai, PhD, Pan-Chyr Yang, MD, PhD
Journal of Thoracic Oncology
Volume 18 Issue 10 Pages 1303-1322 (October 2023)
DOI: 10.1016/j.jtho.2023.06.014
Copyright © 2023 International Association for the Study of Lung Cancer Terms and Conditions

39. Figure 1
and Conditions

40. Figure 2
Journal of Thoracic Oncology 2023 181303-1322DOI: (10.1016/j.jtho.2023.06.014)
Copyright © 2023 International Association for the Study of Lung Cancer Terms and Conditions

41. Figure 3
Journal of Thoracic Oncology 2023 181303-1322DOI: (10.1016/j.jtho.2023.06.014)
Copyright © 2023 International Association for the Study of Lung Cancer Terms and Conditions

42. Figure 4
Journal of Thoracic Oncology 2023 181303-1322DOI: (10.1016/j.jtho.2023.06.014)
Copyright © 2023 International Association for the Study of Lung Cancer Terms and Conditions

43. Figure 5
Journal of Thoracic Oncology 2023 181303-1322DOI: (10.1016/j.jtho.2023.06.014)
Copyright © 2023 International Association for the Study of Lung Cancer Terms and Conditions

44. Figure 6
Journal of Thoracic Oncology 2023 181303-1322DOI: (10.1016/j.jtho.2023.06.014)
Copyright © 2023 International Association for the Study of Lung Cancer Terms and Conditions

45. ACCP: Assessment of the
Probability of Malignancy
Assessment Criteria
Probability of Malignancy
Low (<5%) Intermediate (5%-
65%)
High (>65%)
Clinical factors alone
(determined by clinical
judgement and/or use of a
validated model)
Young, less smoking, no prior
cancer, smaller nodule size,
regular margins, and/or non-
upper-lobe location
Mixture of low and high
probability features
Older, heavy smoking, prior
cancer, larger size,
irregular/spiculated margins,
and/or upper- lobe location
FDG-PET scan results
Low-moderate clinical
probability and low FDG-PET
activity
Weak or moderate FDG-PET
scan activity
Intensely hypermetabolic
nodule
Nonsurgical biopsy results
(bronchoscopy or TTNA)
Specific benign diagnosis
Nondiagnostic
Suspicious for
malignancy
CT scan surveillance
Resolution or near- complete
resolution, progressive or
persistent decrease in size, or
no growth over
≥ years (solid nodule) or ≥
3-5 years (subsolid nodule)
NA
Clear evidence of growth

46. Although every Lung Cancer Screening and Incidental Pulmonary Nodule (IPN) program is different, they all share common pieces. Whether your role is
program building, expanding, and/or navigating, you need to have the final picture in mind.
When assembling any puzzle, experts understand the importance of framing the image. The puzzle (pieces) below describes key insights for lung cancer
screening and IPN programs with foundational pieces on the edges. Utilize these insights to assess, enhance, and frame your lung health program’s picture
in navigating from early detection to lung cancer.
ConsiderationstoEstablishing
QualityCare
inEarlyDetectionandLungCancer
ReferralProcess
Management
CommunityOutreach/
Marketing
Multidisciplinary
Team
CoordinatedCare
PatientEducation
Shared
Decision-Making
IPNandLung
Screening
Protocols
PrimaryCare
Physician
Engagement
Surveillance
Systems
Financialand
Qualit
y
Metrics
5
4
3
1
2
The LungAmbition Alliance, a global coalition with partners acrossdisciplines in
over 50 countries,was formed to combat lung cancer through acceleratinginnova-
tion and driving forward meaningful improvements for people with lung cancer. We
do this by advocatingfor improved approaches in three areas:screening and early
diagnosis,accelerated delivery of innovative medicine, and improved quality care.
InpartnershipwithTheLungAmbitionAllianceandAcademyofOncologyNurse&
PatientNavigators.SponsoredbyAstraZeneca.

47. ReferralProcessManagement
• Standardized referral process for patients considered for lung screening and IPN management1
• Establish effective communication with area primary care physicians for referrals2
• Multidisciplinary teams across multiple facilities, for patient hand-off process
MultidisciplinaryTeamCoordinatedCare
• Dedicated patient navigators1
• Dedicated physician and administrative champions1
• Clearly defined multidisciplinary roles for lung screening and IPN management programs3,4
• Involvement and coordination of thoracic pathologists for specimen review, pulmonologists,
thoracic surgeons,and interventional radiologists3
• Regularly scheduled program quality review meetings1
IPNandLungScreeningProtocols
IPN
• Development of emergency department protocols for management of IPN patients identified
in the emergency department5
• Standardized IPN referral and intake protocols with consideration of establishing a dedicated nodule clinic6
• Communication protocols for IPN patients and their primary care providers
LungScreening
• Standardized lung screening referral and intake protocols7-11
• Communication protocols for lung screening patients and their primary care providers2
SurveillanceSystems
• Implementation of broad-based IT initiatives to support collaboration across clinical settings2
• Standardized and integrated reporting tools for lung nodule programs12,13
• Linkages with data management system/imaging centers, EMR platforms, and standardized
surveillance protocols
• Registration of lung cancer screening facility with the ACR Lung Cancer Screening Registry® (LCSR)14
CommunityOutreach/Marketing
• Community outreach educational initiatives, smoking cessation programs, and tobacco treatment
specialists7,15
• Resources and ongoing strategies to market lung screening and IPN management programs16
• Print and web-based patient resources across the community and targeted groups, including healthcare
providers16
PatientEducationSharedDecision-Making
• Encourage and ensure patients are active participants in the shared decision-making process7
• Offer referrals to pulmonary rehabilitation services following active treatment17
PrimaryCarePhysicianEngagement
• Proactive pattern of communication with primary care physicians for patients undergoing treatment,
surveillance, and follow-up18
Financial andQualityMetrics
• Apply national and/or regional metrics to measure financial impact (costs and benefits) of lung screening
and IPN management programs19
• Financial advocates, navigators, and/or financial counselors to provide support to patients16
• Identify national and/or regional metrics to monitor quality standards20
ConsiderationstoEstablishingQualityCareinEarlyDetectionandLungCancer
1
2
3
4
5
6
7
8
US-57238 12/21

48. Summary
• Lung cancer screening with low-dose CT decreases deaths from lung
cancer
• Screening is not appropriate for everyone
• Only shown to be of benefit for those at higher risk of lung cancer
• Lung cancer screening should be done in structured programs
experienced in lung cancer
• Screening is not a substitute for quitting smoking

49. Hope! Fight! Breathe!

50. Lung Cancer Screening
Future Directions
• Risk prediction models
• Include risk factors other than age, smoking history
• Better determine who should be screened
• Blood test to determine increased risk