It requires a concerted effort by surgeons and physicians to take scientific evidence and convert it into guidelines for practice. Advocacy work must follow the development of these guidelines in order to generate policy for health care delivery.
In the John H. Gibbon, Jr., Lecture, world-renowned thoracic oncology surgeon Douglas E. Wood, MD, FACS, FRSCEd, will describe his own experience researching the benefits of lung cancer screening, the development of screening guidelines, and the subsequent policy work that culminated in this screening as a newly covered benefit in U.S. health care.
Lung Cancer Screening: Saving Lives with Science and Policy will be presented at 9:00 am CDT, Monday, October 5. The lecture will be available for on-demand viewing through the virtual Clinical Congress meeting platform through December 31.
“It’s not good enough to create guidelines, because ultimately, unless an insurance company or Medicare has a policy that will provide coverage, it doesn’t matter how good the guidelines are,” said Dr. Wood, Henry N. Harkins Professor and Chair, department of surgery, University of Washington, Seattle.
In 2009, Dr. Wood was asked to chair a new National Comprehensive Cancer Network (NCCN) guidelines panel for lung cancer screening. A U.S. study of lung cancer screening occurred simultaneously that identified, for the first time, the substantial benefit—a 20 percent reduction in lung cancer mortality—of low-dose CT scans in identifying early stage lung cancer.
“Until this study was done and until the guidelines from the NCCN had been published, there were no recommendations supporting lung cancer screening in the U.S.,” Dr. Wood said. “This really was a fundamental change in identifying a modality for early detection that has the potential of saving 15,000 lives per year in the U.S.”
The National Lung Screening Trial was published in 2011, and NCCN guidelines followed a few months later. Dr. Wood rates the low-dose CT screening as having the most impact of any cancer intervention in a generation in terms of lives saved.
“Early detection allows identification of a cancer when it is treatable and curable, as opposed to identifying a cancer at a late stage where it’s often not curable and often the treatments are more toxic and more expensive,” he said.
The cost of human life lost to lung cancer makes early detection especially significant. More people die of lung cancer in the U.S. than die of breast cancer, colorectal cancer, and pancreatic cancer combined.
The U.S. Preventive Services Task Force revised its guidelines in late 2013 to support lung cancer screening. It took another year for Medicare to also support lung cancer screening. The impact of these two policy decisions was to provide lung cancer screening as a covered benefit to individuals with both private and government health insurance—an enormous advance in public health and access for lung cancer early detection.
During the intervening years, Dr. Wood testified on the subject at a Senate briefing and worked with members of Congress to push Medicare to action. Perhaps most importantly, Dr. Wood was instrumental in helping create a consortium of professional organizations that represented patients, radiology, and thoracic surgery that worked side by side with Medicare administrators to help them understand why a policy for lung cancer screening coverage was necessary, and how concerns about implementation and potential harms could be addressed.
“It was a matter of rolling up the sleeves and working with Medicare in helping them know how to do lung cancer screening and, therefore, be able to implement a national coverage decision that provides for all Medicare beneficiaries,” Dr. Wood said.
The John H. Gibbon, Jr., Lecture, established in 1971 to honor a pioneer in open-heart surgery, is sponsored by the Advisory Council for Cardiothoracic Surgery.