Low-Dose Computed
Tomography
(LDCT)

LDCT is the only screening method proven to reduce lung cancer mortality.
Providers should engage in shared decision making with patients
regarding LDCT screening risks and considerations.

Approximately 50% of lung cancers detected
by LDCT are early stage

  • Number needed to be screened with LDCT to prevent one lung cancer death is 320 over 6.5 years of follow-up with three rounds of annual LDCT screening. 1
  • Relative risk reduction: Compared to those screened with Chest X-Ray (CXR), there were 16% fewer lung cancer deaths among trial participants screened with LDCT. 2
  • Absolute risk reduction: Compared to those screened with CXR, there was 0.33% absolute risk reduction of lung cancer deaths among trial participants screened with LDCT. 1

Early Detection is Important 3

Pie Chart

Five-year lung cancer survival rate is greatest when diagnosed at a localized stage (based on current population data).

Who Should Be Screened

The National Lung Screening Trial (NLST) screened patients who met the following criteria: 1

Adults aged 55-74

Asymptomatic for
lung cancer

30 pack-year
smoking history

Healthy enough to undergo invasive diagnostic procedures and lung resection

Current smokers or those who have quit smoking in the past 15 years

Professional Societies and Organizations vary slightly
in their recommendations

These organizations all recommend LDCT for patients who have a 30 pack-year smoking history,
currently smoke or have quit within the last 15 years.
The American Academy of Family Physicians has concluded that there is insufficient evidence to recommend screening.

Organization Age Considerations
U.S. Preventive Services Task Force 55-80 years
  • Screening should be discontinued if patient develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery
The Centers for Medicare & Medicaid Services 55-77 years
  • The Centers for Medicare & Medicaid Services covers lung cancer screening with LDCT once per year and a visit for counseling and shared decision-making
  • Patients must receive a written order from a provider that meets certain requirements:
    • Documentation of a shared decision-making visit using decision aids to review potential benefits and harms and
    • Counseling on both adherence to annual lung cancer LDCT screening AND on the importance of maintaining cigarette smoking abstinence if former smoker or the importance of smoking cessation if current smoker
American Cancer Society 55-74 years
  • Patients should be referred to a facility that uses “best practices” for CT screening
American Lung Association 55-74 years
  • Informed and shared decision-making with a clinician should occur before any decision is made to initiate lung cancer screening
  • Smoking cessation counseling remains a high priority
  • Screening should not be viewed as an alternative to smoking cessation

Screening Test Results

For every 1000 screened: 1

People Chart

Outcomes of Positive Screening Test Results

Of the 390 with positive results, 96% were false positive 1

People Chart

Other Considerations

Costs

LDCT screening costs are often covered by insurance, but abnormal results may lead to costly surveillance and diagnostic tests and treatment.

The Affordable Care Act mandates coverage for screening, but additional follow-up assessments and treatments may not be fully covered, and patients may face out-of-pocket costs. 4

Radiation

Radiation exposure over time can cause cancer and even lead to cancer deaths.

Approximately 1 cancer death may be caused eventually (after 10–20 years) from radiation per 2500 persons screened. 5

Radiation Comparison 6
LDCT Diagnostic CT Annual Background Chest
X-Ray
Mammogram
1.5 mSv 7 mSv 3-5 mSv 0.1 mSv 0.4 mSv

Availability

LDCT is available in most major hospitals, but may not be accessible in rural areas.

Offer screening only if eligible patients can access appropriate screening and treatment facilities. 7

False Sense of Well-Being

Negative results may give patients a sense of well-being, and discourage tobacco cessation. Providers should offer cessation counseling to all smokers. 8

Provider Talking Points

Screening is recommended only for asymptomatic heavy smokers ages 55 to 80 who have a 30 pack-year smoking history and are current smokers or have quit within the last 15 years.

Quitting smoking is the best way to reduce the risk of dying from lung cancer. Screening is not a substitute for cessation.

Screening makes sense only if the person is healthy enough, willing, and able to undergo invasive diagnostic tests and treatments.

The absolute benefit of screening is small. To achieve this benefit the patient needs to adhere to many years of regular screening.

Most of the lung abnormalities on CT screening are false positives.

Thank you for your time

Click Here For The Brief Survey

Click Here For The Brief Survey:
https://ctsctrials.health.unm.edu/redcap/surveys/?s=C8YPWRKWPX

Credits

Principal Investigators

Shiraz I Mishra MBBS, PhD
Robert L Rhyne, MD

Research Team

Andrew L Sussman, PhD, MCRP
Richard M Hoffman MD, MPH
Tamar Ginossar, PhD
Dolores Guest, PhD, RD
Erika A Robers, MA
Tawny Wilson Boyce, MS, MPH

Executive Producer

Jeanne Gleason, EdD

Instructional Designer

Barbara Chamberlin, PhD

Studio Production Director

Pamela N Martinez

Art Direction

Adrian Aguirre

Editing

Amy Smith Muise

Design & Development

Adrian Aguirre
Kathryn-Mae Eiland
Rene Flores

Studio Support

Stan Carbine
Patricia Clark
Esther Aguirre
Pamela N Martinez
Elizabeth Sohn
Philip McVann
Seth Powers

This research used the facilities or services of the Behavioral Measurement and Population Sciences (BMPS) Shared Resource,
a facility supported by the State of New Mexico and the UNM Comprehensive Cancer Center P30CA118100.
This project was supported by the National Cancer Institutes and the Cancer Center Support Grant through Grant Number 5P30CA118100.
front page
references

References

1. National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011 Aug 4;365(5):395-409. doi: 10.1056/NEJMoa1102873. Epub 2011 Jun 29.

2. Pinsky, PF. Assessing the benefits and harms of low-dose computed tomography screening for lung cancer. Lung Cancer Manag. 2014 Dec 3(6):491-498.

3. Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, et al. SEER Cancer Statistics Review, 1975-2012, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2012/, based on November 2014 SEER data submission, posted to the SEER web site, April 2015.

4. US Department of Health and Human Services. Key Features of the Affordable Care Act. Washington, DC: US Department of Health and Human Services. Available at: http://www.hhs.gov/healthcare/facts/timeline/index.html. Last accessed: July 31, 2015.

5. Bach PB, Mirkin JN, Oliver TK, Azzoli CG, Berry DA, Brawley OW, et al. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA. 2012 Jun 13;307(22):2418-29. doi: 10.1001/jama.2012.5521. PMID: 22610500

6. RadiologyInfo.org. Radiation Dose in X-Ray and CT Exams. Radiological Society of North America, Inc. http://www.radiologyinfo.org/en/info.cfm?pg=safety-xray. Last accessed: March 2, 2016.

7. Wender R, Fontham ET, Barrera E, Jr., Colditz GA, Church TR, Ettinger DS, et al. American Cancer Society lung cancer screening guidelines. CA Cancer J Clin. 2013;63(2):107-17.

8. Zeliadt SB, Heffner JL, Sayre G, Klein DE, Simons C, Williams J, et al. Attitudes and Perceptions About Smoking Cessation in the Context of Lung Cancer Screening. JAMA Intern Med. 2015 Sep;175(9):1530-7. doi: 10.1001/jamainternmed.2015.3558.

Reference:

1. National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011 Aug 4;365(5):395-409. doi: 10.1056/NEJMoa1102873. Epub 2011 Jun 29.

Reference:

2. Pinsky, PF. Assessing the benefits and harms of low-dose computed tomography screening for lung cancer. Lung Cancer Manag. 2014 Dec 3(6):491-49808.

Reference:

3. Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, et al. SEER Cancer Statistics Review, 1975-2012, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2012/, based on November 2014 SEER data submission, posted to the SEER web site, April 2015.

Reference:

4. US Department of Health and Human Services. Key Features of the Affordable Care Act. Washington, DC: US Department of Health and Human Services. Available at: http://www.hhs.gov/healthcare/facts/timeline/index.html. Last accessed: July 31, 2015.

Reference:

5. Bach PB, Mirkin JN, Oliver TK, Azzoli CG, Berry DA, Brawley OW, et al. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA. 2012 Jun 13;307(22):2418-29. doi: 10.1001/jama.2012.5521. PMID: 22610500

Reference:

6. RadiologyInfo.org. Radiation Dose in X-Ray and CT Exams. Radiological Society of North America, Inc. http://www.radiologyinfo.org/en/info.cfm?pg=safety-xray. Last accessed: March 2, 2016.

Reference:

7. Wender R, Fontham ET, Barrera E, Jr., Colditz GA, Church TR, Ettinger DS, et al. American Cancer Society lung cancer screening guidelines. CA Cancer J Clin. 2013;63(2):107-17.

Reference:

8. Zeliadt SB, Heffner JL, Sayre G, Klein DE, Simons C, Williams J, et al. Attitudes and Perceptions About Smoking Cessation in the Context of Lung Cancer Screening. JAMA Intern Med. 2015 Sep;175(9):1530-7. doi: 10.1001/jamainternmed.2015.3558.