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.

This book is a comprehensive guide to lung cancer screening for clinicians, healthcare systems, community leaders, and public health officials with the hope of creating a more equitable landscape in both lung cancer screening and lung cancer-related outcomes, at local, state, and national levels. Authors take a new approach to primary and secondary lung cancer prevention that is in the early stages of adoption in the United States. The last decade ushered in recognition of screening as an effective intervention, but unfortunately, despite the wide acceptance of the importance of this new screening modality, nationally, not more than 5% of eligible subjects have undergone screening to date in the United States, although in some states uptake has reached as high as 16%. As is common with any new preventive cancer screening, racial and socioeconomic disparities emerge in utilization, stage at diagnosis, and mortality. Over time, these disparities decline, but consequential differences endure. Therefore, it is critical to establish equitable screening practices. The true measure of the effectiveness of any lung cancer screening program needs to be viewed through the lens of its impact on populations, including those most affected by the morbidity and mortality of smoking-related illness and lung cancer. As such, this book emphasizes a number of important public health topics, including community outreach to vulnerable populations, social justice issues, addressing stigma and fatalism in the general community, and the use of geocoding to assess a program’s impact at a population level. This book weaves traditional topics related to lung cancer screening, such as promoting initial and repeat screening, interpreting Lung RADs, and managing the follow-up of findings, into the population perspective in order to present a unified, comprehensive approach to the subject. Further, it serves as a guide that health systems, health care professionals, community leaders, and other stakeholders can use to achieve the promise of lung cancer screening.

Lung cancer is the second most diagnosed cancer and remains the leading cause of cancer-related deaths in the United States. The high mortality is largely the consequence of late diagnosis; lung cancer is typically asymptomatic in early stages when a surgical cure is most likely. As a result, there has been great interest in and research on early detection of lung cancer through screening. There is evidence for reduced disease-specific mortality through screening for lung cancer. However, creating an integrated, systematic approach to lung cancer screening remains a challenge for providers. A successful lung cancer screening program weighs the benefits and harms of screening, clearly defines the target population and the screening process, and does not exclude eligible patient populations based on race, ethnicity, or socioeconomic status, In addition it should promote shared decision-making and address risk reduction. Lung Cancer Screening: Essentials for Primary Care provides a comprehensive and pragmatic guide to screening for lung cancer in real world clinical practice. The first two chapters summarize the epidemiology, risk factors and disparities in lung cancer, and provide the evidence base for screening for lung cancer. The disparities in lung cancer among different groups within the US population are well known. This text highlights how health disparities in lung cancer affect screening and have led to modification of lung cancer screening guidelines. Subsequent chapters provide a guide to implementing a successful lung cancer screening program and address the barriers that arise during implementation. The book concludes with real-world solutions to overcoming barriers in lung cancer screening. This pocket guide is an essential read and bookshelf reference for providers who do not have the specialized knowledge of screening for lung cancer. It also appeals to pulmonologists, fellows in Pulmonary Medicine, chest radiologists, and advanced practice providers with an interest in setting up lung cancer screening in any clinical practice.

New technologies and improved understanding of the genesis and progression of various cancers have added to the enthusiasm for potential new strategies to improve screening and early detection of cancer. Research is also under way to evaluate refinements in current screening approaches, including determining optimal screening intervals, the ages at which screening should begin and end, as well as more specific estimates of the potential risks and benefits of screening for certain populations, such as racial and ethnic minority populations and people who have elevated risk for specific cancers. However, there remain significant challenges to developing, validating, and effectively implementing new cancer screening approaches. Guidelines for screening issued by different organizations vary considerably with no clear way of deciding which guidelines are most trustworthy. There is also a need to improve access to high-quality cancer screening and follow-up care, particularly in low-resource communities and among populations who are underserved or have numerous barriers to receiving care. Â To examine the challenges and opportunities related to improving current approaches to cancer screening, as well as the evidence base for novel cancer screening methods, the National Cancer Policy Forum held a workshop, Advancing Progress in the Development and Implementation of Effective, High-Quality Cancer Screening, on March 2-3, 2020, in Washington, DC. This workshop convened a broad range of experts, including clinicians, researchers, statisticians, and patient advocates, as well as representatives of health care organizations, academic medical centers, insurers, and federal agencies. This publication summarizes the presentations and discussions of the workshop and highlights suggestions from individual participants regarding how to improve cancer screening.

Screening programmes involve the systematic offer of testing for populations or groups of apparently healthy people to identify individuals who may be at future risk of a particular medical condition or disease, with the aim of offering intervention to reduce their risk. For many years, screening was practised without debate, and without evidence, but in the 1960s serious challenges were raised about many of the screening procedures then being practised. Benefits and harms of screening must be measured in high quality trials, and the benefits of screening must be weighed alongside the negative side-effects. Concerns were raised about potential and actual harm arising when people without a health problem received dangerous and unnecessary investigations and treatments as a result of routine screening tests. Controversy raged, and it took some 50 years to achieve widespread recognition that evidence-based and quality assured programme delivery was essential, coupled with provision of balanced informed to enable informed choice for potential participants. Commercially motivated provision of poor quality and non-evidence based screening tests is increasing and screening remains a highly contested topic that has relevance in all health systems including for the general public and media. This book serves as a practical and comprehensive guide to all aspects of screening. Following the international success of the first edition, this second edition brings extensive updates and new case study material. The first section deals with concepts, methods, and evidence, charts the story of screening back to 1861, and covers all aspects of a screening programme and how to research the full consequences. The second section is a practical guide to sound policy-making and to high quality delivery of best value screening. The controversies, paradoxes, uncertainties, and ethical dilemmas of screening are explained, and each chapter is packed with examples, real-life case histories, helpful summary points, and self-test questions. Reference is made to the NHS, a leader in screening, but the primary focus is on universal principles, making the book highly relevant across the globe.

While many effective interventions have been developed with the potential to significantly reduce morbidity and mortality from cancer, they are of no benefit to the health of populations if they cannot be delivered. In response to this challenge, Advancing the Science of Implementation across the Cancer Continuum provides an overview of research that can improve the delivery of evidence-based interventions in cancer prevention, early detection, treatment, and survivorship. Chapters explore the field of implementation science and its application to practice, a broad synthesis of relevant research and case studies illustrating each cancer-focused topic area, and emerging issues at the intersection of research and practice in cancer. Both comprehensive and accessible, this book is an ideal resource for researchers, clinical and public health practitioners, medical and public health students, and health policymakers.