Annual low-dose CT screening has been shown to result in high cure rates. However, methods of conducting a lung cancer screening program vary, and best practices have yet to emerge. To address this, the IASLC’s Early Detection and Screening Committee published a perspective that contains considerations for screening program managers to follow.
The report, which focuses on the screening regimen, interpretation of the LDCT, and the subsequent management and treatment, was published in the Journal of Thoracic Oncology, the official journal of the IASLC. These components determine the cure rates of lung cancer that can be achieved under screening said author Claudia Henschke, MD, PhD, who is Professor of Diagnostic, Molecular and Interventional Radiology and Director of the Early Lung and Cardiac Action Program at the Icahn School of Medicine at Mount Sinai in New York.
“This report identifies the key components of a LDCT screening regimen for lung cancer, which include the need for a management system to provide data for continuous updating of the regimen and provides quality assurance assessment of actual screenings,” Dr. Henschke said. “Multi-disciplinary clinical management is needed to maximize the benefit of early detection, diagnosis, and treatment of lung cancer.”
The report outlines several recommendations for screening program managers to consider, including:
- Selection of eligibility criteria
- Counseling of patients to be screened
- Smoking cessation
- Selection of the regimen of screening, which specifies the imaging protocol and workup of LDCT findings
The report also illustrates another important aspect of a lung cancer screening program—timing between screenings.
The benefit of LDCT screening hinges on the detection of small, early lung cancers—when they are curable. Increasing the time between screenings leads to larger and later stage tumors as demonstrated by results from the NELSON lung cancer screening study of annual screening compared with longer intervals of 2 years and 2.5 years between screening.
The report advises that screening programs coordinate with clinical, radiological, and interventional teams as the treatment of lung cancers found by screening helps determine the benefit of LDCT screening.
Ethical considerations regarding eligibility for LDCT screening programs are also discussed as they are important to ensure as many at-risk people receive the benefits of screening as possible. Different regimens have been evolving throughout the world as the resources and needs may be different for countries with limited resources.
“Sharing of results, further knowledge, and incorporation of technologic advances will continue to accelerate worldwide improvements in the diagnostic and treatment approaches,” she said.