Lung Cancer Screening Entails More Than CT Scans (Podcast)

In 2021, the U.S. Preventive Services Task Force expanded its eligibility for lung cancer screening to encompass adults aged 50 to 80 years old who have a 20-pack-year smoking history and currently smoke or have quit within the past 15 years. The change is science-based, taking into consideration research such as the NELSON Study that showed reduced lung cancer mortality with low-dose CT screening.

“The bottom line is absolutely there’s mortality benefit from screening,” says Peter Mazzone, MD, MPH, Director of the Lung Cancer Program and Lung Cancer Screening Program in Cleveland Clinic’s Respiratory Institute. “Lung cancer screening should now be considered standard of care.”

In a featured episode of Cleveland Clinic’s Respiratory Exchange podcast, Dr. Mazzone talks about lung cancer screening, including:

• The difference between screening and diagnostic testing.
• Potential harms of low-dose CT scan for screening.
• Advice for launching a lung cancer screening program.
• The importance of generating awareness and knowledge about screening among the provider community.
• The future of lung cancer screening, including new screening algorithms and population management systems.

Click the podcast player above to listen to the episode now, or read on for a short edited excerpt. Check out more Respiratory Exchange episodes at my.clevelandclinic.org/podcasts/respiratory-exchange or wherever you get your podcasts.

Excerpt from the podcast

Podcast host Raed Dweik, MD, MBA: You’ve spent a lot of time and energy building our lung cancer screening program here. Can you share with our audience … what it takes to establish a lung cancer screening program?

Dr. Mazzone: I like the question because you use the word “program.” … Screening is not just a test here. It is a program. An what’s most important is that the programs are designed to provide really high-quality care. You’re screening the right individuals; you’re using proper imaging techniques. You’re talking to patients about the benefits and harms, letting them make informed decisions about whether to participate.

You have systems in place to manage the findings from the scan, whether it be the lung nodules we talked about or anything else that’s imaged on the chest. You have systems in place to help patients adhere to follow-up recommendations and to the annual scan.

In general, the design of the program only matters in that you have to meet each of those components of high-quality screening that I listed. And in general, the design can be divided into a centralized program or a decentralized program.

Centralized means a provider refers someone to the program, and the program does the rest. They talk to the patient, do the scan, interpret it and manage the findings. Decentralized would be the entire opposite. The primary provider talks to the patient, identifies the right patients, orders the test and then manages all the findings.

One system isn’t necessarily right or wrong; it depends on where you’re practicing and what your resources are. But what’s critical is that each of those components is present.

In general, in the literature, it’s been shown that a centralized program is more likely to screen the proper population; they have better adherence to follow-up recommendations and annual screening. And so we certainly favor centralized screening. But we also have to recognize that every place that has patients eligible doesn’t have the same resources to develop that.

In that situation, I’d suggest connecting or combining with larger health systems, regionally or nationally, to help make sure that you’re checking all the boxes – that you have all these components in place.