How lung cancer screening programs can reach more patients

Lung cancer screening (LCS) with low-dose CT (LDCT) is an effective tool for reducing lung cancer mortality among high-risk individuals, yet utilization of such screening remains low. What can be done to remedy this situation?

The authors of a recent analysis published in the Journal of the American College of Radiology explored this very question, first looking at some issues with how providers presently carry out LCS. One significant problem, the researchers explained, was that LCS programs may be screening individuals who are not necessarily eligible to be screened.  

“In screening-ineligible individuals, we may be violating our edict to ‘do no harm’; these individuals may be more likely to experience adverse downstream effects (ie, false positives and complications of evaluation) than benefit (ie, detection of early-stage lung cancer and reduction in lung cancer mortality),” wrote Matthew Triplette, MD, MPH, department of medicine at the University of Washington in Seattle, and colleagues.

The authors also noted providers are “missing a key opportunity” by focusing on getting LCS participants to quit smoking.

“When screening is performed in conjunction with smoking cessation counseling and shared decision making, there may be a dual benefit of an evaluation for early-stage lung cancer while providing a ‘teachable moment’ for antismoking interventions, such as directed counseling, specialty referral, or pharmacologic therapy,” Triplette et al. wrote. “LCS and smoking cessation have an additive benefit on lung cancer mortality for these individuals.”

Another ongoing issue with LCS utilization is that “individuals of lower socioeconomic status and those who face barriers to care” may be the patients impacted the most when screening programs aren’t implemented as effectively as possible.

“Lung cancer incidence is disproportionately elevated in disparity populations, and smoking rates remain substantially higher in populations with low socioeconomic status and lower levels of education,” the authors wrote.

So what can be done to improve LCS implementation? One potential solution explored by the authors was patient navigation, which has already been shown to improve other screening modalities. Such an individual could be responsible for “patient-facing outreach” such as interviewing patients to determine their eligibility, discuss the risks and benefits of screening and provide assistance in other ways as needed.

Improving how providers identify eligible patients is also important, the authors wrote.

“Providers seem to face numerous barriers in referral to LCS, including simply identifying eligible patients,” the authors wrote. “Electronic health record–based tools used to ‘flag’ eligible patients have been effective in other modes of preventive care; however, the majority of screening-eligible persons may not have accurately recorded smoking information in their medical records.”

By ensuring eligibility information is accurate—especially the smoking history of potential participants—providers can make sure their efforts are being focused on the patients who need LCS the most. This has proven challenging over the years considering some patients may not be honest about their smoking habits, but it an area the authors said could lead to improved LCS implementation.