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Benefits and Risks of low-dose CT screening for lung cancer
A new series of videos describing the benefits and risks of lung cancer screening is in development. In the meantime, below is a high level discussion of benefits, risks and risk reduction strategies. The bottom line is that the benefit of 20% fewer deaths from screening far outweigh the risks in a structured, multi-disciplinary program.
The major benefit seen in high quality studies is:
- 20% reduction in lung cancer mortality in a screened population vs an unscreened population after 3 sequential annual screens and 6-year follow-up without screening. (NLST study)
- An 80% reduction in case fatality in those patients whose lung case was discovered at an early stage with continuous screening. (ELCAP study)
There are risks to lung cancer screening, as in any cancer screening. Many of them can be reduced in a structured, multi-disciplinary program that adheres to guidelines and protocols.
|Risks||Risk Reduction Strategies|
False positive screening results
Complications from invasive diagnostic procedures and surgery, including death.
Use appropriate imaging equipment with low-dose settings and appropriate protocols
Engage radiologists trained in interpreting lung cancer screening CTs
Limit screening to high-risk patients in a well-managed, multi-disciplinary program
Carefully assess of risk malignancy in radiologic lesions prior to invasive procedures including:
Watch a little at a time by clicking on the videos below or watch the entire video at the bottom of the page.
Part 6 - Insurance Coverage for CT Screening
Insurance Coverage for Low Dose CT Screening
A video with detailed information on insurance coverage for lung cancer screening is in development. In the meantime, the good news is that Medicare and commercial insurance plans pay for low dose CT screening in addition to a consultation for shared decision making with no co-payment for eligible patients. The American Lung Association has more information about coverage and eligibility here.
- Cancer Screening Coverage
- Insurance coverage of cancer screening differs widely based on the insurer and state. The matrix on the linked page clarifies coverage.
- Cancer Screening: Guidelines and Insurance Coverage
- This PDF gives a detailed summary of the criteria a person may want to consider in the selection of their cancer screening options.
- Final Recommendation Statement: Lung Cancer Screening
- U.S. Preventive Services Task Force - Final Recommendation Statement: Lung Cancer: Screening, December 2013 - Provides an overview of lung cancer screening, including: recommendation summary, rationale of screening, clinical considerations, implementation of a lung cancer screening program, discussion of lung cancer.
- The Lung Cancer Screening Program Toolkit: 5 steps to get from inception to excellence
- The Advisory Board Company - The Lung Cancer Screening Program Toolkit - Provides information to build a stronger lung cancer screening program or start one from the beginning, the five steps include: evaluate your opportunity, establish program infrastructure, grow volumes, demonstrate program value, and achieve screening program excellence.
- Basic Information About Lung Cancer
- Center for Disease Control and Prevention - Basic Information About Lung Cancer - Provides a general overview of lung cancer, including: what lung cancer is, risk factor, symptoms, risk reduction, available screening tests, diagnosis and treatment, statistics, and what the CDC is doing.
- Lung Cancer Prevention- Health Professional Version (PDQ)
- National Cancer Institute - Lung Cancer Prevention (PDQ®)–Health Professional Version - Overview of lung cancer, including: who is at risk, interventions associated with decreased risk of lung cancer, interventions associated with an increased risk of lung cancer, and interventions that do not decrease risk of lung cancer.
The National Lung Screening Trial: Overview and Study Design Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. Aug 4 2011;365(5):395-409.
Benefits and Harms of CT Screening for Lung Cancer A Systematic Review - Peter B. Bach, MD, MAPP; Joshua N. Mirkin, BA; Thomas K. Oliver, BA; Christopher G. Azzoli, MD; Donald A. Berry, PhD; Otis W. Brawley, MD; Tim Byers, MD, MPH; Graham A. Colditz, MD, DrPH; Michael K. Gould, MD, MS; James R. Jett, MD; Anita L. Sabichi, MD; Rebecca Smith-Bindman, MD; Douglas E. Wood, MD; Amir Qaseem, MD, PhD, MHA; Frank C. Detterbeck, MD
- Explain screening recommendations
- Describe limitations of lung cancer screenings
Quiz and Certificate of Completion
Click Quiz and Certificate of Completion to take a short quiz and reeceive a certificate for this topic.
Dr. Peter Bach MD, Memorial Sloan Kettering Cancer Center
Dr. Peter Bach is the Director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering. Dr. Bach completed undergraduate studies at Harvard University and his Medical Degree from the University of Chicago Harris School. Dr. Bach’s research focuses on the cost and value of anticancer drugs. His work in lung cancer screening has lead to lung cancer screening guidelines and a risk-prediction model for disease.