Low-dose computed tomography (LDCT) lung cancer screening in the San Francisco Health Network
San Francisco Health Network does not currently offer a low-dose computed tomography (LDCT) lung cancer screening program.
Before referring your patient for lung cancer screening, please read the information below.
In response to the results of the National Lung Cancer Screening Trial (NLST), which showed a reduction in lung cancer mortality, the US Preventive Services Task Force recently recommended that screening with LDCT be offered to persons with a history of high-intensity smoking (B level recommendation).
However, guidelines for system-wide implementation of a lung cancer screening program are not yet established. We conducted a detailed analysis of the likely benefits and costs of such a screening program, and concluded, given the high rates of positive testing (most of which are falsely positive), that we are unable to justify prioritizing resources to support such a program.
If you choose to offer LDCT lung cancer screening for your patient, please be aware of the following:
Recommendations and eligibility criteria:
- Three (3) consecutive annual LDCT scans of the chest (based on the NSLT design)
- Age 55 to 80 years,
- At least 30 pack-year smoking history, AND
- Current smokers, or quit recently (within the past 15 years)
Patients not eligible for screening:
- Persons outside of the 55 to 80 years age range
- Persons with less than 30 pack-years smoking history
- Persons who quit smoking over 15 years ago
- Persons with health problems that substantially limits life expectancy
- Persons who do not have the ability or are unwilling to have curative lung surgery
Note: if screening has already been initiated, it should be discontinued with development of any of the above criteria
Key discussion points with patients
- The decision to begin screening should be the result of a thorough discussion of the possible benefits, limitations, and known and uncertain harms.
- Screening cannot prevent most lung cancer deaths, and smoking cessation remains essential.
- Due to the high likelihood of false-positive results and incidental findings, screening may lead to additional (possibly invasive) testing.
- Diagnosis of lung cancer that would not otherwise have affected the patient’s health and the risks of radiation are real harms, although their magnitude is uncertain.
Referring provider responsibilities
- Ordering of LDCT scans in accordance with screening schedule (three (3) consecutive annual LDCT scans)
- Tracking to ensure completion of 3 annual screens
- Follow-up and care coordination of screening scan results
- eReferral to Pulmonary Outpatient Diagnostic Services (PODS) for workup of suspicious radiologic findings
For more information, please see:
- National Lung Screening Trial: http://www.nejm.org/doi/full/10.1056/NEJMoa1102873
- US Preventive Services Task Force statement: http://www.uspreventiveservicestaskforce.org/uspstf13/lungcan/lungcanfinalrs.htm