#LCSM Chat Topic 9/25: Challenges in making LDCT screening chest scans standard of care for high risk patients
It has been a couple of years since the National Lung Screening Trial demonstrated a clear survival benefit for low dose CT (LDCT) screening of patients who have a high risk of lung cancer (with “high risk” defined as age 55-75 and a significant smoking history). While lung cancer screening is offered in programs at various centers around the US, it remains a controversial procedure that has not been approved by Medicare as a covered service. On Thursday, September 25th, 8PM ET/ 5PM PT, we’ll discuss the existing barriers in lung cancer screening in late 2014.
Oft-cited issues are screening cost and cost effectiveness. While it’s clear that most abnormal scans will ultimately prove to represent benign “false positive” findings that may require additional imaging, possibly a biopsy, and may contribute to patient anxiety, a recent actuarial analysis indicates that LDCT screening is cost effective.
But we also see that screening isn’t an entirely data driven decision. Breast cancer recommendations have been reversed based on social and political pressure when the evidence-based guidelines didn’t support screening in younger patients. Primary care physicians may be reluctant to accept lung cancer screening based on a fatalistic view of lung cancer and the American Academy of Family Physicians (AAFP) reluctance to recommend LDCT screening. And patients themselves may drag their feet despite being appropriate candidates, while other low risk patients may aggressively seek screening, based on a misunderstood perception of the real probability of benefit from chest CT screening.
#LCSM previously cohosted a #JACR (Journal of the American College of Radiology) tweetchat on June 26 about patient perspectives on lung cancer screening with LDCT.
With these considerations in mind, we’ll cover these three questions:
T1: With deadline for Medicare decision 11/10, how can the LC community convince decision-makers of benefit of screening?
T2: Assuming coverage, how can we maximize recommendations from PCPs to discuss & order CT screening for appropriate pts?
T3: What do people think of emerging efforts such as breath tests, blood tests, etc? How do they fit into efforts at LC screening?
To participate in the chat, remember to include #LCSM in all your tweets, or use a tweetchat tool like tchat.io and the #LCSM hashtag (more how-to info is here).