1. Making the Case for Lung Cancer Screening
[Insert Organization Name]
Making the Case for Lung Cancer Screening
Introductions
Introduce program and goals of the discussion

2. 2014 Estimated New Cancer Cases
Leading Cause of Cancer Deaths
Second Most Prevalent Cancer Type Among Men and Women
Top Three Tumor Types
2014 Estimated New Cancer Cases
3rd
lung cancer third most prevalent tumor type
232,670
233,000
1st
lung cancer is the leading cause of cancer-related deaths
224,210
27%
lung cancer deaths as a percentage of total cancer- related deaths
Source: American Cancer Society, Fancer Facts and Figures 2014, accessed:
Lung cancer is the third most prevalent cancer type and 2nd most prevalent cancer type in men (after prostate) and second most prevalent cancer type in women (after breast)
Lung cancer is also the leading cause of cancer-related deaths worldwide

3. Lung Cancer Stage at Diagnosis
Lung Cancer Typically Diagnosed At a Late Stage
Lung Cancer Stage at Diagnosis
Non-Small Cell Lung Cancer Five-Year Survival Rates, by Stage at Diagnosis
Source: J Natl Cancer Inst, 100, no.9 (2008): ; Oncology Roundtable interviews and analysis.
This is largely due to the fact that lung cancer is typically diagnosed at a late stage when treatment is less effective
More than half of lung cancers are diagnosed at a late stage
Five-year survival rate decreases significantly as patients are diagnosed at later stages
In comparison, to other cancers, breast, prostate, colon, lung cancer has one of the lowest five year survival rates – overall five year survival for lung cancer is just 16%
Additionally while early detection and screening is available for these other tumor types – think mammography, PSA testing, colonoscopy, none has existed for lung cancer until now….

4. A Key Turning Point
NLST Finds Lung CT Screening Leads to Reductions in Mortality
NLST Results, LDCT
Total Cases
26,000
Negative
72.7%
Positive
27.3%
Incidental Findings
7.5%
20%
percentage reduction in lung cancer mortality in participants that received low-dose CT scans as compared to participants who received standard chest X-rays
Study in Brief: National Lung Cancer Screening Trial
2011 study to assess effectiveness of low-dose lung CT screening
53,454 current and former smokers were randomly assigned to be screened once a year for three years with low-dose CT or chest X-ray
Participants who received low-dose CT scans had a 20% lower risk of dying from lung cancer than participants who received standard chest X-rays
Source: The National Lung Screening Trial Research Team, “Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening,” New England Journal of Medicine, 365, 2011, accessed:
The National Lung Cancer Screening Trial in 2011 screened over 50,000 current and former smokers – each individual was randomly assigned to low-dose CT or chest X-ray for once a year screening for three years
The NLST participants were ages years and had a 30-pack year smoking history
The study found that participants that received low-dose lung cancer screening benefited from a 20% reduction in lung cancer mortality and 7% reduction in overall mortality as compared to individuals that received standard chest X-rays

5. Timeline for CT Lung Cancer Screening Approval
NLST Study Prompts USPSTF Approval
Commercial Reimbursement for Screening Expected 2015
Timeline for CT Lung Cancer Screening Approval
June, 2011 NLST¹ releases initial findings for CT lung cancer screening for high-risk individuals
December, 2013 USPSTF gives low-dose CT lung cancer screening “B” recommendation
January, 2015 lung cancer screening commercial reimbursement expected to begin
2011
2013
2014
2015
2015
June, 2013 USPSTF² releases draft recommendation
April, 2014 MEDCAC³ recommends against Medicare coverage for lung screening
What USPSTF “B” Recommendation Means for Lung Screening Programs
A grade “B” by the USPSTF means that the USPSTF recommends the service and that there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial
The Affordable Care Act requires that all new private health insurance plans cover all preventative services that are rated at a grade “B” or higher by the USPSTF
Source: "Screening for Lung Cancer, U.S. Preventative Services Task Force Recommendation Statement,” USPSTF Final Recommendation Statement, Dec. 2013; Oncology Roundtable interviews and analysis
The NLST study sparked a lot of interest from the cancer care and preventive care community and as such the study led to the United States Preventive Task Force approving lung CT screening and awarding it a grade B
The grade B by the USPSTF essentially means that under the Affordable Care Act all private health plans are required to cover lung screening (or any services graded B or higher by the USPSTF)

6. Societies Recommending CT Lung Cancer Screening
Several Organizations In Support
National Comprehensive Cancer Network
American Lung Association
American Thoracic Society
American Society of Clinical Oncology
American Association for Thoracic Surgery
American Cancer Society
American Association of Bronchology and Interventional Pulmonology
Society of Thoracic Radiology
Society of Thoracic Surgeons
International Association for the Study of Lung Cancer
Oncology Nursing Society
European Society of Thoracic Surgeons
American College of Radiology
Cancer Care Ontario
Societies Recommending CT Lung Cancer Screening
Source: Mckee, A et a;., “Rescue Lung, Rescue Life: Translating the NLST results into clinical practice, Oncology Issues, accessed:
And it’s not just the USPSTF, many other clinical societies are also recommending lung CT screening for high-risk individuals as well

7. Comparing Screening Criteria
Organization
Criteria
National Lung Screening Trial (NLST)
55-74 years old, pack years, stopped smoking less than 15 years ago
United States Preventive Services Task Force (USPSTF)
55-80 years old, 30+ pack years, stopped smoking less than 15 years ago
Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative surgery
National Comprehensive Cancer Network (NCCN)
Category 1a: years old, pack years, stopped smoking less than 15 years ago
Category 2b: 50-74, 20+ pack years, have one additional risk factor excluding second hand smoke
Risk factors include: tobacco smoking, contact with radon, contact with asbestos or other cancer-causing agents (chromium, arsenic, beryllium, cadmium, nickel, coal smoke, soot, silica and diesel fumes, having had certain other cancers, family who’ve had lung cancer, having had other lung diseases (COPD, pulmonary fibrosis)
Source: National Lung Screening Trial Research Team “Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening”  N Engl J Med Aug 4;365(5): Epub 2011 Jun 29. “Screening for Lung Cancer”, USPSTF, ; Shaffer A, “CT Screening Evolves Amid Questions and Controversy”, OncLLive,
Many of these organizations only recommend screening in high-risk individuals and typically involve very specific screening criteria:
Patient Age
Smoking History
Any other risk factors (family history, asbestos exposure, significant second hand smoke exposure etc.)
The screening criteria most commonly used is outlined for you here

8. [Insert Program Screening Criteria Here]
Our screening program plans to use the following screening criteria
Explain if criteria does or does not match NCCN/NLST screening criteria

9. Putting It Into Context
Comparing Mammography and Low-Dose Lung CT Screening
Mammography
Low-dose CT Lung Cancer Screening
False positive rate
10-12%
20-25%
False discovery rate
96%
False positive biopsy rate
7-15% %
Number of individuals need to be screened in order to save one life ~
320
Source: National Lung Screening Trial Research Team “Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening”  N Engl J Med Aug 4;365(5): Epub 2011 Jun 29. “Screening for Lung Cancer”, USPSTF,
Before we go any further, lung CT screening is relatively new, so I thought I’d share some data on how lung CT screening compares to a very well known screening type – mammography
As you can see, it fairs quite well
Though lung CT screening has a higher false positive rate, it has a lower false positive biopsy rate, meaning fewer patients have to undergo invasive follow-up procedures after the screening
Additionally, due to more stringent screening criteria for lung CT screening, lung screening actually has a better rate of return, or you only have to screen 320 patients to save one life as opposed to mammography

10. Early Detection Boosts Cost-Effectiveness
Compares Favorably Compared to Other Screening Types
Shift in Stage of Diagnosis Due To CT Screening
Screening Cost Effectiveness
Change in Number of Lung Cancer Patients Diagnosed by Stage1
Cost Per Life-Year Saved
434%
(25%)
(93%)
Stage A
Stage B
Stage C
Lung CT Screening
Cervical Screening
Breast Screening
Colorectal Screening
$ K
$ K
$ K
$ K
Analysis of lung cancer patient volumes at an academic medical center that sees 5,508 new patients per year; calculations based on 463 new diagnoses of lung cancer.
Source: Pyenson B et al., “An Actuarial Analysis Shows That Offering Lung Cancer Screening as An Insurnace Benefit Would Save Lives at Relatively Low Cost,” Health Affairs 31(4); Oncology Roundtable interviews and analysis.
Not only does lung CT screening compare favorably from a quality standpoint, but also from a cost-effectiveness perspective
Given the shift in stage due to screening, screening actually has the lowest cost-per life saved, comparing favorably against cervical, breast, and colorectal screening

11. Early Detection Boosts Cost Effectiveness (cont.)
Study in Brief: Milliman Actuarial Analysis
2012 actuarial analysis of the effects of LDCT lung cancer screening on outcomes and cost
Lung CT screening would shift detection from late stages to early stages, resulting in 130,000 more lung cancer survivors in 2012
Authors concluded that offering LDCT screening as an insurance benefit would save lives at low cost compared to routine screenings for other cancers
Source: Pyenson B et al., “An Actuarial Analysis Shows That Offering Lung Cancer Screening as An Insurnace Benefit Would Save Lives at Relatively Low Cost,” Health Affairs 31(4); Oncology Roundtable interviews and analysis.
Hidden slide, no need to discuss

12. Apply 3-5% volume estimate to market, or physician panel size
Not A Significant Volume Burden
individuals at “high-risk” for developing lung cancer, according to NLST estimates
10M
Apply 3-5% volume estimate to market, or physician panel size
1,000 x 5% = 50 patients
Primary physician patient panel of 1,000 patients can potentially have about 50 patients that would be eligible for lung CT screening
Source: The National Lung Screening Trial Research Team, “Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening,” New England Journal of Medicine, 365, 2011, accessed:
Now, given the cost and quality benefits of screening, we of course would like to offer the service to individuals who are eligible, or meet the screening criteria
The good news is that this will not be a significant burden on you physicians
NLST estimates put the number of high-risk patients eligible for lung cancer screening at 3-5-% of the US population, so about 10 million nationwide
Bringing this back to the local level – for a primary care physician with a patient panel of about 1,000 patients, this translate to just 50 patients

13. Screening Follow-Up Managed by Program
Lung Cancer Screening Program Flow Map
Add Text Here
To support you, we have developed an extremely comprehensive lung cancer screening program
Let me walk you through the process steps…
Let me highlight your role and responsibilities within each step and how our program can support you…..

14. [Insert Sample Screening Results Report Here]
In terms of follow-up, you can expect….
Here is what the follow-up recommendations mean
What you will have to do
What our program will manage….

15. Insert Program Contact Information
202.XXX.XXXX
[ address]
[Website URL]
For more information, contact us at:
John Smith
XXXXXXXX
Does any one have any questions?
About the referral process?
Screening criteria?
Follow-up processes?
To contact us to make a referral please….