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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Implementation of Lung Cancer Screening: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23680.
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IMPLEMENTATION OF
Lung Cancer Screening

Proceedings of a Workshop

Erin Balogh, Margie Patlak, and Sharyl J. Nass, Rapporteurs

National Cancer Policy Forum

Board on Health Care Services

Health and Medicine Division

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THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Implementation of Lung Cancer Screening: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23680.
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This project was supported by Contract No. 200-2011-38807 (Task Order No. 0051) and Contract No. HHSN263201200074I (Task Order No. HHSN26300052) with the Centers for Disease Control and Prevention and the National Cancer Institute/ National Institutes of Health, respectively, and by the American Association for Cancer Research, American Cancer Society, American College of Radiology, American Society for Radiation Oncology, American Society of Clinical Oncology, American Society of Hematology, Association of American Cancer Institutes, AstraZeneca, Bristol-Myers Squibb, Cancer Support Community, CEO Roundtable on Cancer, Helsinn Healthcare SA, LIVESTRONG Foundation, National Comprehensive Cancer Network, Novartis Oncology, Oncology Nursing Society, and Pfizer Inc. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-45132-1
International Standard Book Number-10: 0-309-45132-9
Digital Object Identifier https://doi.org/10.172216/23680

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2017. Implementation of lung cancer screening: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.172216/23680.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Implementation of Lung Cancer Screening: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23680.
×

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The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.national-academies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Implementation of Lung Cancer Screening: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23680.
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Reports document the evidence-based consensus of an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and committee deliberations. Reports are peer reviewed and are approved by the National Academies of Sciences, Engineering, and Medicine.

Proceedings chronicle the presentations and discussions at a workshop, symposium, or other convening event. The statements and opinions contained in proceedings are those of the participants and have not been endorsed by other participants, the planning committee, or the National Academies of Sciences, Engineering, and Medicine.

For information about other products and activities of the National Academies, please visit nationalacademies.org/whatwedo.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Implementation of Lung Cancer Screening: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23680.
×

WORKSHOP PLANNING COMMITTEE1

GRETA MASSETTI (Chair), Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention

LORI HOFFMAN HŌGG, Veterans Health Administration National Oncology Clinical Advisor and Program Manager, Prevention Policy, Department of Veterans Affairs

SAMIR N. KHLEIF, Professor of Medicine, Biochemistry, Molecular Biology, and Graduate Studies, Augusta University

BARNETT KRAMER, Director, Division of Cancer Prevention, National Cancer Institute

LEE M. KRUG, Disease Area Head, Lung and Head & Neck Cancer, Immuno-Oncology, Bristol-Myers Squibb

CHRISTOPHER S. LATHAN, Assistant Professor of Medicine, Harvard Medical School; Director, Cancer Care Equity, Dana-Farber Cancer Institute

JENNIFER A. PIETENPOL, Director, Vanderbilt-Ingraham Cancer Center; Executive Vice President for Research, Vanderbilt University Medical Center; and Benjamin F. Byrd, Jr. Professor of Oncology, Vanderbilt University

YA-CHEN TINA SHIH, Professor of Health Economics, Chief, Section of Cancer Economics and Policy, Department of Health Services Research, University of Texas MD Anderson Cancer Center

ROBERT SMITH, Vice President, Cancer Screening, American Cancer Society

JAMIE L. STUDTS, Associate Professor, Department of Behavioral Science, University of Kentucky College of Medicine; Director, Behavioral & Community-Based Research Shared Resource Facility, Markey Cancer Center

DANIEL SULLIVAN, Professor Emeritus, Department of Radiology, Duke University School of Medicine

___________________

1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Implementation of Lung Cancer Screening: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23680.
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ROBERT J. VOLK, Professor, Department of Health Services Research, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center

Project Staff

SHARYL J. NASS, Director, National Cancer Policy Forum

ERIN BALOGH, Senior Program Officer

CYNDI TRANG, Research Assistant

PATRICK ROSS, Research Assistant (until July 2016)

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Implementation of Lung Cancer Screening: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23680.
×

NATIONAL CANCER POLICY FORUM1

MICHAEL CALIGIURI (Chair), Chief Executive Officer, James Cancer Hospital and Solove Research Institute; Director, The Ohio State University Comprehensive Cancer Center

PATRICIA A. GANZ (Vice Chair), Distinguished Professor, University of California, Los Angeles, Fielding School of Public Health; Director, Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center

AMY P. ABERNETHY, Chief Medical Officer and Senior Vice President for Oncology, Flatiron Health

LUCILE ADAMS-CAMPBELL, Professor of Oncology, Associate Director for Minority Health and Health Disparities Research, Georgetown University Lombardi Cancer Center

KENNETH ANDERSON, Kraft Family Professor of Medicine, American Cancer Society Clinical Research Director, Jerome Lipper Multiple Myeloma Center, Harvard Medical School, Dana-Farber Cancer Institute

MONICA M. BERTAGNOLLI, Richard E. Wilson Professor of Surgery, Harvard Medical School; Chief, Division of Surgical Oncology, Dana-Farber/Brigham and Women’s Cancer Center; Group Chair, Alliance for Clinical Trials in Oncology

OTIS W. BRAWLEY, Chief Medical Officer, American Cancer Society

ROBERT W. CARLSON, Chief Executive Officer, National Comprehensive Cancer Network

GREGORY CURT, Executive Director, External Scientific and Clinical Relations, U.S. Medical Affairs, AstraZeneca

WENDY DEMARK-WAHNEFRIED, Professor and Webb Endowed Chair of Nutrition Sciences, Associate Director for Cancer Prevention and Control, University of Alabama at Birmingham Comprehensive Cancer Center

___________________

1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Implementation of Lung Cancer Screening: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23680.
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GEORGE D. DEMETRI, Professor of Medicine, Harvard Medical School; Director, Ludwig Center; Senior Vice President for Experimental Therapeutics, Dana-Farber Cancer Institute; Associate Director for Clinical Sciences, Dana-Farber/Harvard Cancer Center

JAMES H. DOROSHOW, Deputy Director for Clinical and Translational Research, National Cancer Institute

JOHN FRIEND II, Senior Vice President, Helsinn Therapeutics

LORI HOFFMAN HŌGG, Veterans Health Administration National Oncology Clinical Advisor and Program Manager, Prevention Policy, Department of Veterans Affairs

LINDA HOUSE, President, Cancer Support Community

HEDVIG HRICAK, Chair, Department of Radiology, Memorial Sloan Kettering Cancer Center

LISA KENNEDY SHELDON, Chief Clinical Officer, Oncology Nursing Society; Editor, Clinical Journal of Oncology Nursing

SAMIR N. KHLEIF, Professor of Medicine, Biochemistry, Molecular Biology, and Graduate Studies, Augusta University

RONALD M. KLINE, Medical Officer, Patient Care Models Group, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services

LEE M. KRUG, Disease Area Head, Lung and Head & Neck Cancer, Immuno-Oncology, Bristol-Myers Squibb

RICHARD A. LARSON, Professor of Medicine and Director, Hematologic Malignancies Clinical Research Program, The University of Chicago Comprehensive Cancer Center

MICHELLE M. LE BEAU, Arthur and Marian Edelstein Professor of Medicine and Director, The University of Chicago Comprehensive Cancer Center

GRETA MASSETTI, Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention

DANIEL R. MASYS, Affiliate Professor, Biomedical and Health Informatics, University of Washington School of Medicine

MARTIN J. MURPHY, Chief Executive Officer, CEO Roundtable on Cancer

LOYCE PACE, Executive Director, Global Health Council (LIVESTRONG Representative)

RICHARD PAZDUR, Director, Oncology Center of Excellence; Acting Director, Office of Hematology and Oncology Products, Food and Drug Administration

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Implementation of Lung Cancer Screening: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23680.
×

STEVEN PIANTADOSI, Phase One Foundation Endowed Chair and Director, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center

JENNIFER A. PIETENPOL, Director, Vanderbilt-Ingraham Cancer Center; Executive Vice President for Research, Vanderbilt University Medical Center; and Benjamin F. Byrd, Jr. Professor of Oncology, Vanderbilt University

MACE L. ROTHENBERG, Chief Development Officer, Oncology, Pfizer Global Product Development, Pfizer Inc.

RICHARD L. SCHILSKY, Senior Vice President and Chief Medical Officer, American Society of Clinical Oncology

DEBORAH SCHRAG, Chief, Division of Population Sciences, Professor of Medicine, Department of Medical Oncology, Harvard Medical School, Dana-Farber Cancer Institute

YA-CHEN TINA SHIH, Professor of Health Economics, Chief, Section of Cancer Economics and Policy, Department of Health Services Research, University of Texas MD Anderson Cancer Center

ELLEN V. SIGAL, Chair and Founder, Friends of Cancer Research

RALPH WEICHSELBAUM, Daniel K. Ludwig Professor and Chair, Department of Radiation; Oncology and Cellular Director, Ludwig Center for Metastasis Research, The University of Chicago Medical Center

GEORGE J. WEINER, President, Association of American Cancer Institutes; C.E. Block Chair of Cancer Research, Professor of Internal Medicine, and Director, Holden Comprehensive Cancer Center, University of Iowa

RICHARD WOODMAN, Senior Vice President and Head, North America Oncology Clinical Development & Medical Affairs, Novartis Pharmaceuticals Corporation

WENDY WOODWARD, Associate Professor and Section Chief of Clinical Breast Radiation, Department of Radiation Oncology, University of Texas MD Anderson Cancer Center

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Implementation of Lung Cancer Screening: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23680.
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National Cancer Policy Forum Staff

SHARYL J. NASS, Forum Director and Director, Board on Health Care Services

ERIN BALOGH, Senior Program Officer

SYLARA MARIE CRUZ, Senior Program Assistant

MATINA KAKALIS, Summer Intern (May-July 2016)

KIMBERLY MAXFIELD, Mirzayan Science and Technology Policy Fellow (January-May 2016)

PATRICK ROSS, Research Assistant (until July 2016)

CYNDI TRANG, Research Assistant

PATRICK BURKE, Financial Officer

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Implementation of Lung Cancer Screening: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23680.
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Reviewers

This Proceedings of a Workshop has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published Proceedings of a Workshop as sound as possible and to ensure that the Proceedings of a Workshop meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this Proceedings of a Workshop:

MICHAEL K. GOULD, Kaiser Permanente

ELLA KAZEROONI, University of Michigan

MICHAEL L. LEFEVRE, University of Missouri

PETER MAZZONE, Cleveland Clinic

IDE MILLS, Patient Advocate

Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the Proceedings of a Workshop before its release. The review of this Proceedings of a Workshop was overseen by SUSAN J. CURRY, University of Iowa. She

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Implementation of Lung Cancer Screening: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23680.
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was responsible for making certain that an independent examination of this Proceedings of a Workshop was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this Proceedings of a Workshop rests entirely with the rapporteurs and the institution.

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Implementation of Lung Cancer Screening: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23680.
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IN MEMORIAM

This Proceedings of a Workshop is dedicated to Dr. Gregory Curt, an accomplished physician and scientist, a valued member of the National Cancer Policy Forum, and an irreplaceable colleague and friend.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Implementation of Lung Cancer Screening: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23680.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Implementation of Lung Cancer Screening: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23680.
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Acknowledgments

Support from the many annual sponsors of the National Academies of Sciences, Engineering, and Medicine’s National Cancer Policy Forum is crucial to the work of the Forum. Federal sponsors include the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health. Non-federal sponsors include the American Association for Cancer Research, American Cancer Society, American College of Radiology, American Society for Radiation Oncology, American Society of Clinical Oncology, American Society of Hematology, Association of American Cancer Institutes, AstraZeneca, Bristol-Myers Squibb, Cancer Support Community, CEO Roundtable on Cancer, Helsinn Healthcare SA, LIVESTRONG Foundation, National Comprehensive Cancer Network, Novartis Oncology, Oncology Nursing Society, and Pfizer Inc.

The Forum wishes to express its gratitude to the expert speakers whose presentations helped examine the policy and implementation issues in lung cancer screening. The Forum also wishes to thank the members of the planning committee for their work in developing an excellent workshop agenda.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Implementation of Lung Cancer Screening: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23680.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Implementation of Lung Cancer Screening: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23680.
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Acronyms and Abbreviations

AAFP

American Academy of Family Physicians

AATS

American Association for Thoracic Surgery

ACA

Patient Protection and Affordable Care Act

ACCP

American College of Chest Physicians

ACR

American College of Radiology

ACS

American Cancer Society

AHRQ

Agency for Healthcare Research and Quality

ALA

American Lung Association

ASCO

American Society of Clinical Oncology

ATS

American Thoracic Society

BI-RADS Breast Imaging Reporting and Data System
CDC Centers for Disease Control and Prevention

CMS

Centers for Medicare & Medicaid Services

COPD

chronic obstructive pulmonary disorder

CT

computed tomography

DANTE

Detection and Screening of Early Lung Cancer by Novel Imaging Technology and Molecular Essays

DLCST

Danish Lung Cancer Screening Trial

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Implementation of Lung Cancer Screening: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23680.
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EMR

electronic medical record

FDA Food and Drug Administration
GOLF

Groupe d’Oncologie de Langue Française

HEDIS

Healthcare Effectiveness Data and Information Set

IASLC

International Association for the Study of Lung Cancer

I-ELCAP

International-Early Lung Cancer Action Program

IFCT

French Cooperative Thoracic Intergroup

IPDAS

International Patient Decision Aids Standards Collaboration

LDCT low-dose computed tomography

Lung-RADS

ACR Lung Imaging Reporting and Data System

MEDCAC

Medicare Evidence Development and Coverage Advisory Committee

NCCN National Comprehensive Cancer Network

NCD

national coverage determination

NCI

National Cancer Institute

NELSON

Nederlands-Leuvens Longkanker Screenings Onderzoek

NLST

National Lung Screening Trial

PET positron emission tomography

PLCO

Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial

PROSPR

Population-based Research Optimizing Screening through Personalized Regimens

QALY quality-adjusted life year
USPSTF U.S. Preventive Services Task Force
VA Department of Veterans Affairs
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The public health burden from lung cancer is substantial: it is the second most commonly diagnosed cancer and the leading cause of cancer-related deaths in the United States. Given the individual and population health burden of lung cancer, especially when it is diagnosed at later stages, there has been a push to develop and implement screening strategies for early detection. However, many factors need to be considered for broad implementation of lung cancer screening in clinical practice. Effective implementation will entail understanding the balance of potential benefits and harms of lung cancer screening, defining and reaching eligible populations, addressing health disparities, and many more considerations.

In recognition of the substantial challenges to developing effective lung cancer screening programs in clinical practice, the National Academies of Sciences, Engineering, and Medicine held a workshop in June 2016. At the workshop, experts described the current evidence base for lung cancer screening, the current challenges of implementation, and opportunities to overcome them. Workshop participants also explored capacity and access issues; best practices for screening programs; assessment of patient outcomes, quality, and value in lung cancer screening; and research needs that could improve implementation efforts. This publication summarizes the presentations and discussions from the workshop.

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