Should Your Patient Be Screened for Lung Cancer?
June 15, 2022
Criteria for those eligible have expanded
UH Clinical Update | June 2022
More patients are eligible for low-dose CT screening for lung cancer under new guidelines adopted by the U.S. Preventive Services Task Force and endorsed by the pulmonologists, thoracic surgeons and lung cancer specialists at University Hospitals. The team at UH says it hopes these updated recommendations will encourage more patients to take advantage of this vital screening test. Lung cancer screening is now also recommended by the American Academy of Family Physicians.
Previously, patients age 55 to 77 with a 30 pack-year smoking history were eligible for the test. The new guidelines lower the age to 50 and the pack-years requirement to just 20 years.
“We’re going to really improve the breadth of who is eligible to receive screening because now patients who have fewer pack years smoking and are younger can start the lung cancer screening process,” says Catalina Teba, MD, with the Division of Pulmonary, Critical Care and Sleep Medicine at University Hospitals Cleveland Medical Center.
Dr. Teba says evidence showing the benefit of lung cancer screening documented since the initial National Lung Cancer Screening Trial paved the way for the newly expanded guidelines, opening up the option to both more patients and a more diverse population of patients.
“There’s been more evidence since that trial showing that lung cancer screening works and helps find lung cancer early,” she says. “We’ve been building on that study with additional bodies of evidence. Another reason for reducing the age requirements is because there’s support that doing earlier screening to include more patients is helpful in addressing racial disparities. Some minority groups smoked less pack-years because they smoked different kinds of tobacco products, so this helps include them. We’re trying to be more inclusive with our lung cancer screening eligibility.”
Other criteria for lung cancer screening remain unchanged. These include:
- Current smoker, or has quit within the past 15 years
- No symptoms of lung cancer, such as coughing up blood or weight loss
- Able to undergo treatment of lung cancer, if needed
- No other life-limiting illness
- Written order from his/her doctor
Patients with suspicious findings on the low-dose CT scan are evaluated by a multidisciplinary UH team with representatives from pulmonology, thoracic radiology, thoracic surgery, oncology and radiation oncology. These meetings provide guidance to primary care providers on how to approach the management of lung nodules, lung masses and other findings from the lung cancer screening CT scans. UH also has developed notes for electronic medical records (EMRs) to make it easy to communicate with primary care providers about their patients.
“We now have two nurse navigators helping manage the Lung Cancer Screening Program, and we coordinate with our colleagues in the lung nodule clinics at UH Parma and UH Geauga. The program is larger, better coordinated, and more robust than we were a few years ago,” Dr. Teba says.
Another key aspect of the lung cancer screening program is offering patients smoking cessation services. These are available through the UH Smoking Cessation Program, or patients are referred to the State of Ohio program through the number 1-800-QUIT-NOW.
A few practical considerations with lung cancer screening: Any patient with an active respiratory infection should wait 12 weeks after treatment to be screened, says Benjamin Young, MD, Director of Interventional Pulmonology, UH Cleveland Medical Center.
“Patients should not have any new respiratory symptoms that might be concerning for an active infection, such as a changing or new cough when undergoing lung cancer screening,” says Dr. Young. “Active respiratory tract infections increase the risk of false positive screening results.”
Providers referring patients for lung cancer screening should use code Z87.891 (former smoker or history of nicotine dependence) or F17.210 (current smoker or nicotine dependent). UH recommends referring patients who have a Lung-RADS (Lung CT Screening Reporting and Data System) of 3 or higher to pulmonary and/or thoracic surgery to assist with further evaluation. Last, Medicare Part B covers lung cancer screening for patients who meet all of the eligibility criteria. However, patients are required to participate in a documented counseling and shared decision-making meeting upon enrollment in the program and before initial screening.
Dr. Teba says she hopes more patients will take advantage of the new expanded eligibility criteria for lung cancer screening. A thoughtful discussion with a primary care provider, she says, can set the stage what can be a life-saving test.
“We definitely know that there are more patients out there who we have not reached, so we’re always trying to get the word out, educate and expand the number of patients who are undergoing screening,” she says. “We want to help them, if they do have lung cancer, find it sooner, undergo treatment sooner and have an improved mortality outcome.”
“Patients may not understand how treatable lung cancer is with modern techniques, and may avoid screening for it as a result,” she adds. “However, there are improved options for treating and curing lung cancer today. We’ve come a long ways in the past couple of decades with lung cancer treatment, and the UH Seidman Cancer Center team is experienced in state-of-the-art lung cancer treatment. But appropriate screening is the crucial first step.”