1. Lung Cancer Screening:
Current Recommendations and Case Examples
Stacy Moulton, M.D.
Radiologic Associates of Fredericksburg

2. Lung Cancer Facts:
#1 Cause of cancer deaths in the U.S. for MEN and WOMEN
More deaths than breast, colorectal, and prostate combined
~222,500 new lung cancer diagnoses in 2017 per ACS
Mostly a disease of mature adults (82% of those living with lung cancer are 60 yrs or older)

3. Lung Cancer and Smoking:
Smoking contributes to 80% and 90% of lung cancer deaths in men and women, respectively
Men are 23 times more likely to develop lung cancer (women 13 times) compared to those who never smoked
The greater the time gap from stopping smoking, the more similar the risk of cancer, coronary artery disease and other smoking related health issues approaches that of non-smokers

4. Survival stats: Lung cancer overall 5 yr survival rate 18%
breast (90%), colorectal (65%), and prostate (>99%)
Lung cancer survival rate jumps to near 50% when isolated to the lungs
only 15% of lung cancer diagnosed at this early stage
Currently, more the ½ of people with lung cancer die within 1 year of diagnosis

5. SCREENING!!!

6. But How???
Xrays?

7. But How???
CAT Scan (CT)?

8. But How???
CAT Scan (CT)?

11. Lung Screening: NLST 53,454 individuals 55-74 yrs
30 pack year smoking history
current smoker or quit within past 15 yrs
24% of initial screening exams were POSITIVE
Of all positive exams, 96% were false positive (NO CANCER)

12. Lung Screening: 20% FEWER cancer deaths in CT arm vs XRAY arm
All-cause death rate decreased by 6.7% in the CT arm

13. USPTF grade B
Dec 2013
Required by the Affordable Care Act to be covered by commercial payers at NO COST to the patient

14. CMS/Medicare approval!!
Positive Coverage granted Feb 2015
55-77 yrs
30 pack yr smoking history
Current smoker or quit within past 15 years
No signs or symptoms of lung cancer
Initial “shared decision making” visit
G0296
Must include ICD-9 V15.82, ICD-10 Z87.891, personal history of tobacco use/nicotine dependence

15. Medical Imaging of Fredericksburg and Mary Washington Healthcare Lung Cancer Screening Program
An integrated program to locally screen, diagnose and treat lung cancer in our community.

16. Lung Screening Program:
High Quality, integrated program
ACR accredited Lung Cancer Screening Center
Core group of imagers
Referral to lung nodule specialist (Pulmonary Associates of Fredericksburg) if needed
Highly regarded thoracic surgeon (Tim Sherwood, MD)
Lung cancer conference and multidisciplinary approach to diagnosis and treatment

17. CT Lung Screening Options:
CMS
55-77 yrs of age
At least 30 pack year smoking hx
Current smoker or quit in past 15 yrs
No signs or symptoms of lung cancer

18. CT Lung Screening Options:
NCCN
50 yrs and older
At least 20 pack year smoking hx
One additional risk factor (other than 2nd hand smoke)
- Discontinue screening if health situation results in limited life expectancy or the ability/willingness to undergo treatment

19. CT Lung Screening Options:
50 yrs and older
At least 20 pack year smoking hx
One additional risk factor (other than 2nd hand smoke)

20. Lung-RADS Screening and Reporting Data System
Standardize lung cancer screening CT reporting and management recommendations
Facilitate outcome monitoring
ACR registry

23. Lung Screening Program:
Patient tracking
MIF CT Screening Coordinator
ACR Registry
Patient and Clinician reminder letters

24. Lung Screening Program:
Since CMS approval 464 patients entered screening program
40 Lung-RAD 4 exams
10 Cancer Dxs

25. Lung Screening Program:
CASE EXAMPLES

26. 69 y/o Female, 60 pack year

28. Lung-RADS 4X
Recommend chest CT with or without contrast, PET/CT and/or tissue sampling depending on the probability of malignancy and
comorbidities. Consider referral to lung nodule specialist

29. Lung-RADS 4X
Recommend chest CT with or without contrast, PET/CT and/or tissue sampling depending on the probability of malignancy and
comorbidities. Consider referral to lung nodule specialist

30. Lung-RADS 4X
Small Cell Carcinoma

31. 68 y/o Male, 100 pack year

33. Lung-RADS 4X
Recommend chest CT with or without contrast, PET/CT and/or tissue sampling depending on the probability of malignancy and
comorbidities. Consider referral to lung nodule specialist

35. NSCLC T1aN0M0; Stage IA 5yr survival near 50%
Lung-RADS 4X
NSCLC T1aN0M0; Stage IA
5yr survival near 50%

36. Thank you!