Lung Cancer Screening A Pulmonary Revolution William P. Saliski, JR. DO, FCCP Montgomery Pulmonary Consultants

Lung Cancer in the U.S. 2013 228, 190 new cases 159,480 deaths vs. 120,000 deaths from breast, colon, and prostate cancer combined. 90% of lung cancer deaths (205,000) are in current or former smokers. Overall 5 year survival rate is 16%

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NUTS/BOLTS OF THE STUDY August 2002 – April 2004 Enrolled 53,454 “high risk patients” 33 US medical centers Random assignment to CT chest or CXR Yearly study (x3 years) Data collected on cases of lung cancer and death

Results Rate of adherence 90% CT chest – positive screen 24.2% Chest x-ray – positive screen 6.9% CT chest – 96.4% false positive Chest x-ray – 94.5% false positive

CAT SCAN GROUP CHEST X-RAY GROUP Incidence of lung cancer – 645/100,000 person years 247 deaths / 100,000 CHEST X-RAY GROUP Incidence of lung cancer – 309/100,000 person years 309 deaths / 100,000

Conclusion Screening with the use of low-dose CT reduces mortality 20% from lung cancer

CMS - February 5, 2015 – landmark decision to cover the cost of low dose CT screening(LDCT) for lung cancer. ACA – requires commercial carriers to provide coverage by end of 2015

Organization Endorsements National Comprehensive Cancer Network American Society of Clinical Oncology American College of Chest Physicians American Thoracic Society American Cancer Society American Lung Association

An Official American Thoracic Society/American College of Chest Physicians Policy Statement: Implementation of Low-Dose Computed Tomography Lung Cancer Screening Programs in Clinical Practice Renda Soylemez Wiener, Michael K. Gould, Douglas A. Arenberg, David H. Au, Kathleen Fennig, Carla R. Lamb, Peter J. Mazzone, David E. Midthun, Maryann Napoli, David E. Ost, Charles A. Powell, M. Patricia Rivera, Christopher G. Slatore, Nichole T. Tanner, Anil Vachani, Juan P. Wisnivesky, and Sue H. Yoon; on behalf of the ATS/CHEST Committee on Low-Dose CT Lung Cancer Screening in Clinical Practice Abstract Rationale: Annual low-radiation-dose computed tomography (LDCT) screening for lung cancer has been shown to reduce lung cancer mortality among high-risk individuals and is now recommended by multiple organizations. However, LDCT screening is complex, and implementation requires careful planning to ensure benefits outweigh harms. Little guidance has been provided for sites wishing to develop and implement lung cancer screening programs. Objectives: To promote successful implementation of comprehensive LDCT screening programs that are safe, effective, and sustainable. Methods: The American Thoracic Society (ATS) and American College of Chest Physicians (CHEST) convened a committee with expertise in lung cancer screening, pulmonary nodule evaluation, and implementation science. The committee reviewed the evidence from systematic reviews, clinical practice guidelines, surveys, and the experience of early-adopting LDCT screening programs and summarized potential strategies to implement LDCT screening programs successfully. Measurements and Main Results: We address steps that sites should consider during the main three phases of developing an LDCT screening program: planning, implementation, and maintenance. We present multiple strategies to implement the nine core elements of comprehensive lung cancer screening programs enumerated in a recent CHEST/ATS statement, which will allow sites to select the strategy that best fits with their local context and workflow patterns. Although we do not comment on cost-effectiveness of LDCT screening, we outline the necessary costs associated with starting and sustaining a high-quality LDCT screening program. Conclusions: Following the strategies delineated in this policy statement may help sites to develop comprehensive LDCT screening programs that are safe and effective. Copyright © 2015 by the American Thoracic Society

Baptist Medical Center / Montgomery Cancer Center Steering Committee Baptist Medical Center / Montgomery Cancer Center Pulmonary Medicine – Dr. Franco / Dr. Saliski Primary Care – Dr. Saliba Radiology – Dr. Rucker, Jackie Davis, Tommy Patterson (Director) Medical Oncology – Dr. Barnes Pathology – Dr. Borak Nursing – Kim Barkley, CIC ????????? Nurse Navigation – Ashley Truesdale, MCC Administration – Laura Hamilton, Susan Reed, Jeff Hicks Respiratory Therapy – Yolanda Yates PAC’S – Stacy Sparks

Low Dose CT Screening for Lung Cancer 2015 Medicare Requirements Current Smokers or former smokers that quit in the last 15 years ages 55-77 30 pack year smoking history or 20 pack year smoking history with other factors ACA requires Commercial Insurance to cover by the end of 2015

PENLUNG LDCT LUNG SCREENING MANAGEMENT SYSTEM