Michael A. Pritchett, DO, MPH
For doctors who see patients at risk of developing lung cancer, a panel of experts from the American Lung Association and the American Society for Thoracic Game (ATS) has been created.1 In this pragmatic guide, experts from various US institutions provide a set of tools for designing, implementing, and implementing lung cancer screening programs.
"The problem is that 75% of lung cancers are in stage III or IV where we cannot operate and if [patients] they have some rare molecular mutation, usually progress and die of lung cancer, ”said Michael A. Pritchett, DO, MPH, FirstHealth of Carolinas and Pinehurst Medical Clinic in Pinehurst, North Carolina in an interview with MD Magazine®.
“A few years ago, she found out we can [reduce] mortality [by 20%] by performing a low dose screening with a CT scan, Pritchett. “All major companies have agreed that this is useful and can actually create what is called a phase shift. We want to change this and reverse these numbers, so at least 75% of patients are in stage I or II [and] we can do surgery or just radiation therapy. "
The document was compiled using survey information to address real-world approaches to common problems encountered in lung cancer screening and program implementation for which there is no guidance or consensus statement.
Criteria for screening
Annual lung cancer screening for individuals at risk of developing lung cancer is recommended by major health organizations, including CMS and the US Preventive Services Task Force. According to Dr. Pritchetta must be patients from 55 to 77 years of age, with smoking in 30 packages per year. They must also be asymptomatic and have not had a CT scan in the last year.
“When we started it, we were all sent to lung cancer screening. [But] if they do not meet the criteria, CMS does not pay for it. Primary care physicians must learn the criteria, know where patients can be scanned, and know that we can take care of them [if they find something], "Said Dr. Pritchett.
Basic areas of lung cancer screening programs
Political statements by the American College of Chest Physicians and ATS addressed who is being investigated, CT performance, reporting, lung management, smoking cessation, patient and provider education, and data collection to ensure that the benefits of lung cancer screening outweigh potential damage. is implemented.
Lung cancer screening programs should collect data on the risk of developing lung cancer in all subjects. The program must confirm the existing policy on individuals to be screened, requiring that ≥ 90% of all subjects tested comply with this policy.
Low-dose CT for lung cancer screening should be performed on the basis of American American Radio of Society of Thoracic Radiology and programs should collect data to verify that the average radiation dose is consistent with these recommendations.
A structured reporting system is recommended and lung cancer screening programs should collect compliance data. The program should confirm that at least 90% of CT monitor reports are followed by a reporting system.
Regarding lung node control algorithms, programs should include the following:
- Doctors with expertise in the treatment of lung nodes and lung cancer treatment
- Node characterization method and its monitoring
- Communication approach between client and patient
- Gathering usage and monitoring results and diagnostic imaging and biopsies for management
Lung cancer screening programs must be integrated with a smoking cessation program and data on interventions offered to active smokers should be collected.
Physicians must be instructed to discuss the risks and benefits of screening in patients. Lung cancer screening programs must include educational strategies used to educate providers and demonstrate the availability of standardized learning materials.
Lung cancer screening programs are required to collect data on each component, test results and cancer diagnoses and this information must be reported to the supervisory authority annually. The program must respond to the concerns of this supervisor in order to maintain accreditation.
"The key food stand is to know the parameters, and for every patient who meets these parameters, I want them to be sent to a CT scan for lung cancer, and then we'll take care of the rest," said Dr. Pritchett. "We understand that primary care physicians are impressed, and yes, we ask one more thing. But this other thing can save someone's life. "
1. Thomson CC, McKee A, Borondy-Kitts A, et al. American Chest Society and American Lung Association. Implementation Guide for Lung Cancer Screening. lung.org/assets/documents/lung-cancer/implementation-guide-for-lung.pdf. Accessible on October 31, 2018.