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Wood DE, Kazerooni EA, Baum SL, Eapen GA, Ettinger DS, Hou L, Jackman DM, Klippenstein D, Kumar R, Lackner RP, Leard LE, Lennes IT, Leung ANC, Makani SS, Massion PP, Mazzone P, Merritt RE, Meyers BF, Midthun DE, Pipavath S, Pratt C, Reddy C, Reid ME, Rotter AJ, Sachs PB, Schabath MB, Schiebler ML, Tong BC, Travis WD, Wei B, Yang SC, Gregory KM, Hughes M. Lung Cancer Screening, Version 3.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 16:412-441. [PMID: 29632061 DOI: 10.6004/jnccn.2018.0020] [Citation(s) in RCA: 379] [Impact Index Per Article: 75.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lung cancer is the leading cause of cancer-related mortality in the United States and worldwide. Early detection of lung cancer is an important opportunity for decreasing mortality. Data support using low-dose computed tomography (LDCT) of the chest to screen select patients who are at high risk for lung cancer. Lung screening is covered under the Affordable Care Act for individuals with high-risk factors. The Centers for Medicare & Medicaid Services (CMS) covers annual screening LDCT for appropriate Medicare beneficiaries at high risk for lung cancer if they also receive counseling and participate in shared decision-making before screening. The complete version of the NCCN Guidelines for Lung Cancer Screening provides recommendations for initial and subsequent LDCT screening and provides more detail about LDCT screening. This manuscript focuses on identifying patients at high risk for lung cancer who are candidates for LDCT of the chest and on evaluating initial screening findings.
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Fintelmann FJ, Bernheim A, Digumarthy SR, Lennes IT, Kalra MK, Gilman MD, Sharma A, Flores EJ, Muse VV, Shepard JAO. The 10 Pillars of Lung Cancer Screening: Rationale and Logistics of a Lung Cancer Screening Program. Radiographics 2015; 35:1893-908. [PMID: 26495797 DOI: 10.1148/rg.2015150079] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
On the basis of the National Lung Screening Trial data released in 2011, the U.S. Preventive Services Task Force made lung cancer screening (LCS) with low-dose computed tomography (CT) a public health recommendation in 2013. The Centers for Medicare and Medicaid Services (CMS) currently reimburse LCS for asymptomatic individuals aged 55-77 years who have a tobacco smoking history of at least 30 pack-years and who are either currently smoking or had quit less than 15 years earlier. Commercial insurers reimburse the cost of LCS for individuals aged 55-80 years with the same smoking history. Effective care for the millions of Americans who qualify for LCS requires an organized step-wise approach. The 10-pillar model reflects the elements required to support a successful LCS program: eligibility, education, examination ordering, image acquisition, image review, communication, referral network, quality improvement, reimbursement, and research frontiers. Examination ordering can be coupled with decision support to ensure that only eligible individuals undergo LCS. Communication of results revolves around the Lung Imaging Reporting and Data System (Lung-RADS) from the American College of Radiology. Lung-RADS is a structured decision-oriented reporting system designed to minimize the rate of false-positive screening examination results. With nodule size and morphology as discriminators, Lung-RADS links nodule management pathways to the variety of nodules present on LCS CT studies. Tracking of patient outcomes is facilitated by a CMS-approved national registry maintained by the American College of Radiology. Online supplemental material is available for this article.
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Affiliation(s)
- Florian J Fintelmann
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Adam Bernheim
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Subba R Digumarthy
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Inga T Lennes
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Mannudeep K Kalra
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Matthew D Gilman
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Amita Sharma
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Efren J Flores
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Victorine V Muse
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Jo-Anne O Shepard
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
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