COMMENTARY

Early Detection Means It's a Promising Time for Lung Cancer

Lisa Richardson, MD

Disclosures

October 24, 2016

Editorial Collaboration

Medscape &

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Hello. I'm Dr Lisa Richardson, director of CDC's Division of Cancer Prevention and Control. I'm pleased to speak with you as part of the CDC Expert Commentary series on Medscape. While most of you may be aware that lung cancer is the leading cause of cancer death and the second most common cancer among both men and women in the United States, the sheer numbers can be shocking. Each year, more than 200,000 people are diagnosed with lung cancer and 150,000 die, representing nearly 25% of all deaths from cancer in this country.[1] The most important thing that Americans who smoke can do to lower their risk for lung cancer is to quit smoking.[2] However, early detection by screening is another important strategy for patients in whom the risk for lung cancer is high.[3] Most people who are eligible for lung cancer screening are former smokers.

The US Preventive Services Task Force recommends yearly screening with low-dose CT scans for men and women age 55-80 years who have no symptoms of lung cancer but who are current heavy smokers or were heavy smokers who quit within the past 15 years. This means that you are probably seeing patients in your office every day who could benefit from lung cancer screening.

The Agency for Healthcare Research and Quality (AHRQ) has developed tools for which reimbursement is available for informed shared decision-making visits. They will assist you in determining which of your patients are eligible for lung cancer screening and in helping them make informed decisions about whether it's right for them.[4] For example, the Clinician's Checklist helps determine the patient's eligibility by taking into account age, smoking status and history, and other factors, such as whether the patient is healthy enough to have lung surgery, based on your clinical judgment.

Figure. Lung Cancer Screening: A Clinician's Checklist. AHRQ, March 2016.

After you determine that a patient is eligible for screening, you will want to have a conversation with him or her about the potential benefits and harms of screening. This decision-making process is necessary before moving forward with a scan. The potential benefit is reduced mortality from lung cancer. The potential harms include false-positive results, follow-up testing if an abnormality is found, possible complications of invasive testing, and radiation exposure.[5] Follow-up testing procedures can lead to major complications, such as infections, bleeding in the lung, collapsed lungs, and even death. Screening may have reduced benefit in patients with poor health. Discuss any comorbidities that the patient has that may reduce the benefit of screening, and talk to your patient about his or her willingness to undergo invasive diagnosis and treatment.

The AHRQ's Clinician's Checklist has a step-by-step guide for having a shared decision-making discussion with your patient, as well as a Decision-making Tool for Patients and Clinicians that includes visual aids.

When considering reimbursement, it is important to note that lung cancer screening is the only shared decision-making visit that is reimbursed by Medicare. You use HCPCS code G0296. You can find more information on the CMS website. This visit may be done by a physician, physician assistant, nurse practitioner, or clinical nurse specialist.[6]

Importantly, screening is not a substitute for quitting smoking. If your patient still smokes, use the "5 A's" (ie, ask, advise, assess, assist, and arrange) to help them quit.[7] Evidence shows that even brief counseling by a physician or nurse can help more patients quit for 1 year or more. In a comprehensive review, smokers who were offered advice to quit by a physician were 76% more likely to have quit at 6 months or longer.[7,8] Effective interventions can be delivered by physicians, nurses, and others. Free resources are available at smokefree.gov. If your patient has stopped smoking, be sure to congratulate them and reinforce that they stay smoke-free.

The screening frequency is yearly as long as the patient continues to be eligible and he or she doesn't develop a health problem that reduces their life expectancy or willingness to undergo testing.

Early detection works. Only 1 of 20 lung cancer patients survive for 5 years if the disease has already spread.[9] If we find lung cancer early, more than half survive for 5 years. This is a promising time for lung cancer: Rapid breath tests are on the horizon, and we can test tumors for genetic markers to prescribe the best treatments for our patients. Lung cancer doesn't have to be the death sentence it used to be.

Web Resources

Effective Health Care Program: Patient Decision Aids

Cancer Prevention & Control

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