Promoting Responsible Lung Cancer Screening Across the United States: Lessons From The Lung Cancer Alliance Screening Centers of Excellence

Background and context: In 2010, the National Lung Screening Trial was halted in the United States after showing a 20% reduction in mortality for high risk individuals when three years of annual lung cancer screening was performed by low dose computed tomography (LDCT). Many questions remained about whether this type of screening could be properly implemented in nonacademic, community settings. Aim: Our aim was to promote high-quality, responsible lung cancer screening throughout the United States, including in community settings where most lung cancer is diagnosed. Strategy/Tactics: Lung Cancer Alliance developed a National Framework for Excellence in Lung Cancer Screening and Continuum of Care in 2012 and began a nationwide network dedicated to responsible lung cancer screening. The Screening Center of Excellence designation requires a center to ensure shared decision-making, comply with best practice standards, work with a multidisciplinary care team, refer for smoking cessation, provide results in a timely manner, and meet standards set by the American College of Radiology. Program/Policy process: From 2012 through 2016, over 500 centers were designated as Screening Centers of Excellence. These centers represented 42 states and more than 60% were from community/nonacademic community centers. High-risk individuals who come to the Lung Cancer Alliance Web site or contact the organization by phone to find a screening center are directed to a Center of Excellence. A data collection effort in 2017 collected comprehensive information about the state of lung cancer screening and care at their institution. Nearly 70% of centers responded to the survey. Outcomes: This program has helped promoted high quality lung cancer screening throughout the United States. Our program data shows that screening is being performed widely across the United States, including in nonacademic centers. For centers who were able to provide numbers of screenings performed and diagnoses, we identified a clear trend in diagnosis of Stage 1 lung cancer, indicating these screenings are able to find lung cancer early. We also identified a number of implementation challenges around referral patterns, insurance and billing, and determining appropriate risk criteria. What was learned: We have shown that a patient advocacy group working with medical professionals can help deliver high quality care to a broad population. Data collection from the Screening Centers of Excellence provides a snapshot of the state of lung cancer screening in the United States that underscores the success of LDCT and the importance of early detection but also identifies barriers in implementation that still need to be addressed.