P3.11-07 The Quality of Screening: Comparing the Rush Lung Cancer Screening Program to the NLST and the VA Lung Cancer Screening Demonstration Project

Abstract

The National Lung Screening Trial (NLST) was conducted for the purpose of determining the efficacy of using a low dose computed tomography (LDCT) scan to screen for lung cancer screening versus chest x-ray. Findings demonstrated a reduction in mortality by 20.0%. In 2013, informed by the findings from the NLST, the United States Preventative Services Task Force (UPSTF) gave lung cancer screening a grade B recommendation. This recommendation eventually led to both private insurance coverage and in 2015, Centers for Medicare and Medicaid Services (CMS) coverage of low dose computed tomography (LDCT) scans to screen for lung cancer. In 2017, the US Department of Veterans Affairs (VA) published the experience of implementing a lung cancer screening program (LCSDP). This publication attracted the attention of the medical community and media, generating concern over the value of LDCT scans indicated to screen for lung cancer. The Rush University Medical Center Lung Cancer Screening Program (RLCSP) is in its third year of implementation and adheres to best practices for the evolving discipline of lung cancer screening. To compare the structure and findings of the Rush Lung Cancer Screening Program (RLCSP) to two well-known published initiatives: the National Lung Screening Trial (NLST) and Implementation of Lung Cancer Screening in the Veterans Health Administration (LCSDP). 1 in 29 people screened with the RLCSP has lung cancer, compared with 1 in 68 people screened with the LCSDP, and 1 in 320 screened with the NLST. The RLCSP has a more diverse demographic base, and fewer false positive scans than the NLST or LCSDP. The NLST is a research study that was conducted for the purpose of testing the efficacy of using a LDCT scan versus chest x-ray to screen for lung cancer. The purpose of the LCSDP is to address feasibility of implementing a lung cancer screening program within the VA system; The LCSDP is an implementation project and not a clinical research study. RLCSP is a screening program that was implemented in a university hospital setting, which closely adheres to best practices with strong results. Data from the RLCSP supports findings from the NLST that LDCT is an effective scan to screen for lung cancer.