Meeting NewsPerspective

Only 1.9% of eligible heavy smokers screened for lung cancer

Danh Pham

Of more than 7 million current and former heavy smokers eligible for screening, only 1.9% underwent screening in 2016, according to an analysis of national screening sites scheduled for presentation at the ASCO Annual Meeting.

“Lung cancer remains the number one cancer killer in America — killing more people than breast, colon, pancreatic and prostate cancers combined annually — with an estimated of 154,040 deaths projected in 2018 alone,” Danh Pham, MD, medical oncologist at the James Graham Brown Cancer Center at University of Louisville, said during a press cast. “In 2011, the National Lung Screening Trial results showed there was a 20% lower risk for dying of lung cancer with a low-dose CT scan.”

Since 2013, the United States Preventive Services Task Force recommended people aged 55 to 80 years who are current or former heavy smokers — defined as at least 30 cigarette pack-years — be screened for lung cancer using low-dose CT. In 2015, CMS expanded Medicare coverage to include lung cancer screening for this population.

Pham and colleagues analyzed screening rates following expanded insurance coverage using data from the 2016 American College of Radiology’s Lung Cancer Screening Registry for 1,796 accredited screening sites. They used 2015 data from the National Health Interview Survey to determine the number of screening-eligible current or former smokers.

Results showed 7,612,975 current and former heavy smokers were eligible nationwide for screening. However, only 1.9% of eligible people (n = 141,260) underwent screening at the accredited sites.

The analysis also included stratification based on the four U.S. census regions in the country: Northeast, South, Midwest and West.

The South had the most screening sites (n = 663) compared with the rest of the U.S., as well as almost 3 million former and current heavy smokers eligible for screening. However, the screening rate was only 1.6%.

The West had the lowest screening rate at 1% compared with 3.5% in the Northeast and 1.9% in the Midwest.

These screening rates are significantly lower compared with other cancer types, Pham said. For example, in 2015, about 65% of women aged 40 years or older had a mammogram.

“This ultimately begs the question on the root of the disparity,” Pham said. “Are physicians not referring patients enough, or are eligible patients not wanting screening, even if they know a test was available? Lung cancer is particularly unique in that there may be a stigma associated with screening, where cancer is attributed to a modifiable risk factor through heavy smoking and the at-risk population may be deterred from wanting screening if diagnosing cancer results in confirming a poor lifestyle choice.”

In order to increase screening rates, Pham recommended making lung cancer screening a national quality health measure, the same way CMS made breast cancer screening and colonoscopy a national area of improvement in 2008.

Primary care physicians generally recommend patients for screening and, therefore, should also be made aware of the screening data, according to Pham. – by Cassie Homer

Reference:

Pham D, et al. Abstract 6504. Scheduled for presentation at: ASCO Annual Meeting; June 1-5, 2018; Chicago.

Disclosures: Bristol-Myers Squibb Foundation helped fund this study. Pham reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.

Danh Pham

Of more than 7 million current and former heavy smokers eligible for screening, only 1.9% underwent screening in 2016, according to an analysis of national screening sites scheduled for presentation at the ASCO Annual Meeting.

“Lung cancer remains the number one cancer killer in America — killing more people than breast, colon, pancreatic and prostate cancers combined annually — with an estimated of 154,040 deaths projected in 2018 alone,” Danh Pham, MD, medical oncologist at the James Graham Brown Cancer Center at University of Louisville, said during a press cast. “In 2011, the National Lung Screening Trial results showed there was a 20% lower risk for dying of lung cancer with a low-dose CT scan.”

Since 2013, the United States Preventive Services Task Force recommended people aged 55 to 80 years who are current or former heavy smokers — defined as at least 30 cigarette pack-years — be screened for lung cancer using low-dose CT. In 2015, CMS expanded Medicare coverage to include lung cancer screening for this population.

Pham and colleagues analyzed screening rates following expanded insurance coverage using data from the 2016 American College of Radiology’s Lung Cancer Screening Registry for 1,796 accredited screening sites. They used 2015 data from the National Health Interview Survey to determine the number of screening-eligible current or former smokers.

Results showed 7,612,975 current and former heavy smokers were eligible nationwide for screening. However, only 1.9% of eligible people (n = 141,260) underwent screening at the accredited sites.

The analysis also included stratification based on the four U.S. census regions in the country: Northeast, South, Midwest and West.

The South had the most screening sites (n = 663) compared with the rest of the U.S., as well as almost 3 million former and current heavy smokers eligible for screening. However, the screening rate was only 1.6%.

The West had the lowest screening rate at 1% compared with 3.5% in the Northeast and 1.9% in the Midwest.

These screening rates are significantly lower compared with other cancer types, Pham said. For example, in 2015, about 65% of women aged 40 years or older had a mammogram.

“This ultimately begs the question on the root of the disparity,” Pham said. “Are physicians not referring patients enough, or are eligible patients not wanting screening, even if they know a test was available? Lung cancer is particularly unique in that there may be a stigma associated with screening, where cancer is attributed to a modifiable risk factor through heavy smoking and the at-risk population may be deterred from wanting screening if diagnosing cancer results in confirming a poor lifestyle choice.”

In order to increase screening rates, Pham recommended making lung cancer screening a national quality health measure, the same way CMS made breast cancer screening and colonoscopy a national area of improvement in 2008.

Primary care physicians generally recommend patients for screening and, therefore, should also be made aware of the screening data, according to Pham. – by Cassie Homer

Reference:

Pham D, et al. Abstract 6504. Scheduled for presentation at: ASCO Annual Meeting; June 1-5, 2018; Chicago.

Disclosures: Bristol-Myers Squibb Foundation helped fund this study. Pham reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.

    Perspective
    Bruce E. Johnson

    Bruce E. Johnson

    I work in lung cancer, and I would certainly love to be put out of business by an effective screening program.

    One of the things Id point out with this study is that screening was first approved to be reimbursed in 2015, so this is the first year or so this is not a measure of steady state but a measure of this first being implemented.

    Second, its very disappointing how uncommon screening is. It should be saving 12,000 lives per year, according to a recent study, but with this screening rate its saving about 250 people per year instead.

    There is a certain stigma among people who smoke who feel as if they deserve it or it is self-punishment. This study will certainly be a call to action. We hope that the message will get out there and people who have smoked cigarettes for 30 pack-years or longer will get screened for lung cancer.

    We need to think about quality health measures, like Dr. Pham mentioned. ASCO is working with the American College of Physicians and some of the other primary care groups to try to get the message out about screening.

    • Bruce E. Johnson , MD, FASCO
    • ASCO President Dana-Farber Cancer Institute

    Disclosures: Johnson reports stock and other ownership interests with KEW Group; honoraria from Chugai Pharma and Merck; consulting/advisory roles with Amgen, AstraZeneca, Boehringer Ingelheim, Chugai Pharma, Clovis Oncology, Eli Lilly, Genentech, KEW Group, Merck, Novartis and Transgene; research funding from Novartis; royalties from Dana-Farber Cancer Institute; and expert testimony with Genentech.

    Perspective
    Daniel Oh

    Daniel Oh

    This abstract is a timely reminder that we as a nation have not started lung cancer screening in earnest. However, are we expecting too much too soon? This study focuses on 2016 data and it is important to note the sequence of events leading up to that year. The results of the landmark National Lung Screening Trial were published in August 2011, followed by the USPSTF recommendation to offer low-dose CT (LDCT) for high-risk individuals in December 2013. CMS did not give their coverage approval until February 5, 2015, and, in that intervening time, there had been concerns among clinicians that CMS was not going to approve it, which placed many physicians in limbo about whether or not to offer LDCT due to insurance coverage concerns. Finally, when CMS did approve it, they stipulated that screening centers must report to a CMS-approved registry, which is essentially the American College of Radiology (ACR) Lung Cancer Screening Registry. However, although our own center was one of the first to apply for entry into the ACR registry as soon as CMS gave approval, we did not become an ACR registry participant until July 2015.

    In this context, 2016 should really be the baseline measurement of lung screening when all of the logistical components and coverage issues had been resolved, and we can only get better from there.

    Nonetheless, no one wants to hear excuses. Not many patients want to have a colonoscopy, but roughly 60% of eligible patients receive it. LDCT is much easier and more pleasant than a colonoscopy, so we need to meet at least that level of compliance. This study is a call to action for improving adoption of LDCT and raising awareness amongst primary care physicians. Our patients are depending on it.

    • Daniel Oh, MD
    • Keck School of Medicine of USC

    Disclosures: Oh reports no relevant financial disclosures.

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