Michael A. Pritchett, DO, MPH
For doctors who see patients at increased risk of developing lung cancer, a new guide for the implementation of lung cancer screening programs have been developed by the expert group from the American Lung Association and the American Thoracic Society (ATS).1 This pragmatic leadership, experts from various US institutions provide tools for how to develop, implement and cancer screening programs lungs.
"The problem is that 75% of lung cancer cases are not at a stage III or stage IV, where we can not do the surgery, and if [patients] There are some rare molecular mutations, and they usually die from lung cancer, "said Michael A. Pritchett, DO, MPH, from the Carolinas to FirstHealth and Pinehurst Medical Clinic in Pinehurst, North Carolina in an interview with & # 39; w MD Magazine®.
"A few years ago, Screening Trial National Lung found that we can [reduce] mortality [by 20%] making screening with low-dose CT, "said Dr. Pritchett. "All the major public agreed that it is useful and can really create what is called a shear stage. We want to move that turn these figures, so that at least 75% of patients are at stage I or stage II [and] we can do the surgery or radiotherapy alone. "
The document was based on information from a survey designed to solve real-world approaches to common problems in the screening of lung cancer and the implementation of programs, for which the indicative or consensus statements may not exist.
Annual lung cancer screening for people at risk of developing lung cancer is recommended by leading health organizations, including CMS and the US Task Force preventive services. According to Dr. Pritchett, patients should be 55 to 77 years, with a history of 30 pack-years of smoking. In addition, they should be asymptomatic and have had CT scans in the past year.
"When we started this, we were getting each sent for screening of lung cancer. [But] if they do not meet the criteria, CMS will not pay for it. primary care physicians should examine the criteria to know, where patients can be scanned, and know that we can take care of it [if they find something], "Said Dr. Pritchett.
The main domains of lung cancer screening programs
Political statement from the American College of Chest Physicians and the SD addressed, which screened the performance of CT, reporting, bundles of light control, smoking cessation, the patient and the education provider, as well as the collection of data to ensure that the benefits of screening legkihov cancer outweigh the potential harm as it is implemented.
lung cancer screening program to collect data on the risk of lung cancer for all subjects ,. The program should confirm the existing policy in respect of persons who are offered screening, with the requirement that ≥90% of all surveyed sub & # 39 objects consistent with this policy.
Low-dose CT screening for lung cancer should be based on the American College of Radiology and the Society of Thoracic Radiology specifications, as well as programs to collect data to ensure that the average dose to meet these guidelines.
Structured reporting system is recommended, and lung cancer screening program should collect data related to performance. The program must prove that at least 90% of reports CT screen following the reporting system.
As for the control algorithms nodule lung program you should include the following:
- Clinicians who have experience in the management of lung nodules and treatment of lung cancer
- The process-node performance and tracking control
- Approach the relationship between patient and provider order
- Data collection on the use and the results of the surveillance and diagnostic imaging and biopsy to control
Lung cancer screening programs should be integrated with the program of smoking cessation, and data should be collected in respect of the measures proposed by active smokers.
Clinicians need to be educated, to discuss the risks and benefits of screening with patients. Lung cancer screening programs should be listed educational strategies used for training providers and to demonstrate the existence of a standardized educational material.
The program is easy to collect data necessary cancer screening related to each component, test results and diagnoses of cancer, and these data should be submitted annually to the supervisory authority. The program should respond to the challenges of this controlling body to maintain accreditation.
"The key is to know the parameters of removal, and for each patient, which corresponds to this parameter, I want them to be sent for CT lung cancer screening, and then we can take care of the rest," said Dr. Pritchett. "We understand that primary care physicians are overloaded, and so we ask for one more thing. But this is another thing that can save someone's life. "
1. Thomson CC, Mack A, Borondy-A Kitts, et al. American Thoracic Society and the American Lung Association. Guide to Implementing Screening for lung cancer, Lung.org/assets/documents/lung-cancer/implementation-guide-for-lung.pdf. Accessed October 31, 2018.