Lung Cancer Screening With Low-Dose CT in the United States

The findings of the landmark National Lung Screening Trial (NLST)—showing a 20% reduction in lung cancer mortality when screening with low-dose CT (LDCT), compared with chest radiography—marked a turning point in the field of lung cancer screening, influencing organizational recommendations and leading to increasing acceptance of LDCT for screening of individuals at high risk for lung cancer. However, many practices and institutions have experienced barriers in their attempts to implement successful screening programs; these include challenges in maintaining the same high caliber of screening programs as those in the NLST, confusion regarding insurance reimbursement protocols, and a lack of resources to help physicians discuss the specifics of LDCT screening with their patients.To address these challenges, standards are being established to ensure consistent quality of screening programs, including certification standards and protocols maintained by the ACR. In addition, the US Preventive Services Task Force’s “B” rating, given to LDCT screening in late 2013, resulted in mandated private insurance coverage beginning in 2015 and the 2015 CMS coverage determination has spurred previously reluctant organizations to prepare for population-based screening. Despite these successes, protocols for billing and claims processing are still evolving and organizations are considering how best to implement the shared decision-making process required by CMS. Despite some procedural setbacks that have yet to be resolved, LDCT screening for individuals at high risk of lung cancer has grown substantially since its effectiveness was shown by the NLST in 2011.