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

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)

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

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

SCREENING!!!

But How??? Xrays?

But How??? CAT Scan (CT)?

But How??? CAT Scan (CT)?

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)

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

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

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

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.

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

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

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

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

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

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

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

Lung Screening Program: CASE EXAMPLES

69 y/o Female, 60 pack year

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

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

Lung-RADS 4X Small Cell Carcinoma

68 y/o Male, 100 pack year

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

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

Thank you!