LDCT Lung Cancer Screening Lowers Risk of Mortality in High-Risk Patients

The annual rate of newly diagnosed lung cancer cases in Missouri is 76.2 per 100,000 people. This number puts the state higher than the national average (63.0) and places it 6th highest in the country.

The statistics, released by the American Lung Association’s LUNG FORCE State of Lung Cancer Report, opens new tab in February 2018, also reveal only 18.6% of lung cancer cases in Missouri are diagnosed early. North Kansas City Hospital’s low-dose CT lung cancer screening can diagnose lung cancer at an early stage, decreasing the likelihood of lung cancer-related mortality.

“LDCT lung cancer screening is a preventive measure,” said Benjamin E. Northrup, MD, opens new tab, a radiologist with Northland Radiology. “Our goal is to identify small pulmonary nodules before metastasis.”

Low-dose chest CT reveals suspicious lung mass in a 
patient who smoked a pack a day for 40 years.

Reduced Mortality

The recent Dutch-Belgian Randomized Lung Cancer Screening Trial, called the NELSON study, opens new tab, showed that annual lung cancer screening with LDCT in high-risk patients reduced lung cancer deaths by 26% in men and up to 61% in women. The 10-year, population-based, randomized controlled trial, which began in 2003, involved 15,792 participants who underwent more than 27,000 scans. Scans occurred in years one, two, four and six. The individuals were 50-74 years old and at high risk for lung cancer based on responses to a general questionnaire.

“The subjects were screened with low-dose CT versus nothing else,” Dr. Northrup said. “Although these countries have a bit higher smoking rate and different risk factors, the results are compelling.”

LDCT also provides increased sensitivity for the diagnosis of lung cancer compared with chest X-ray. In the National Lung Screening Trial, opens new tab, participants who received LDCTs had a 20% lower risk of mortality from lung cancer than those who received standard chest X-rays. The 53,454 asymptomatic subjects were current or former heavy smokers (at least 30 pack-years) and ages 55-74. The 2002-2004 trial randomly assigned subjects to three annual screenings with either LDCT or X-ray. There were 247 deaths from lung cancer per 100,000 person-years in the LDCT group and 309 deaths per 100,000 person-years in the radiography group.

“If patients meet the screening criteria, the data show a clear benefit, in terms of lung cancer mortality reduction,” Dr. Northrup said.

Patient Criteria

Medicare Part B covers LDCT lung cancer screening once a year if patients meet all the following eligibility criteria:

• Age 55-77 years
• Have no signs or symptoms of lung cancer
• Have a tobacco history equivalent to smoking a pack a day for 30 years (30 pack-years)
• Be a current smoker or one who has quit smoking within the last 
  15 years
• Have a written order for a LDCT lung cancer screening received during a lung cancer screening counseling and shared decision-making visit:
  • G0296 — Counseling visit to discuss need for lung cancer screening using low-dose CT scan (service is for eligibility determination and shared decision-making)
  • G0297— Low-dose CT scan for lung cancer screening

Because the U.S. Preventive Services Task Force also recommends LDCT lung cancer screening, most private insurance companies cover the test and office counseling visit. The USPSTF recommends screening cease when an individual turns 81.

Benjamin E. Northrup, MD

Dr. Northrup, opens new tab earned his medical degree from Dartmouth Medical School. He completed his residency and fellowship at the Mallinckrodt Institute of Radiology.