By Michael Gieske, MD, For the Rescue Lung Society
Lung cancer remains the leading cause of cancer death in the United States, claiming as many lives each year as breast, prostate, and colorectal cancers combined. Yet, unlike these other cancers, lung cancer is more often diagnosed at a late stage—when treatment options are more limited and outcomes are often less satisfactory. Fortunately, there is a powerful tool that can change this trajectory: low dose computed tomography (LDCT) lung cancer screening.
Despite strong evidence and national guidelines supporting LDCT screening for high-risk individuals and excellent insurance coverage, uptake remains dismally low. According to recent estimates, 16% or less of eligible patients undergo lung cancer screening. Bridging this gap requires more than awareness, it demands strategic activation of primary care providers, groups, and networks and the clinicians at their heart.
Primary Care Providers: The Gatekeepers of Prevention and Early Detection
Primary care providers (PCPs) are uniquely positioned to change the landscape of lung cancer, being on the front lines of cancer prevention care. They know their patients’ histories, building trust over time. And, critically, they are often the only point of contact for their patients’ health maintenance.
When PCPs champion lung cancer screening, their recommendations carry weight. Studies show that a provider’s endorsement is the most important determinant of whether a patient completes lung screening. Conversely, the absence of a provider conversation often leads to missed opportunities for early detection, increased suffering, and incurring far greater expense.
However, significant barriers persist. Time constraints, evolving and various eligibility guidelines, and the complexity of shared decision-making (SDM) often leave lung cancer screening deprioritized in already overburdened primary care settings. To change this, we must integrate screening for the number one cancer killer into the very fabric of routine preventive care—not as an afterthought or lessor priority, but as a standard, expected practice alongside mammography, colonoscopy, and Pap smears.
Yet in a deeply disappointing move, the National Committee for Quality Assurance (NCQA) disbanded its Technical Expert Panel (TEP) in June of this year, halting progress and substantial efforts toward formulating a dedicated HEDIS (Healthcare Effectiveness Data and Information Set) measure for lung cancer screening. This measure would have been a game changer, placing lung cancer screening on equal footing with the other nationally endorsed major cancer screening quality metrics. The overarching Committee for Performance Metrics (CPM) precluded implementation of this measure amongst concerns of addressing mandated SDM and over screening, singling out lung cancer as uniquely bound by these constraints.
The panel’s abrupt dissolution of the TEP this May and the greater than two years of effort, to date, is more than a missed opportunity—it is a profound setback. It undermines years of anticipation and advocacy aimed at dismantling the stigma, nihilism, and underuse that have long plagued lung cancer. Rebuilding momentum—and trust—will, most unfortunately, take years to realign and redirect.
Primary Care Networks: A Critical Infrastructure
In the interim, many health systems that have succeeded in scaling up lung cancer screening share a common thread: they leverage organized primary care providers and networks and team-based coalitions to identify and refer eligible patients. These networks ideally and often include:
- Leveraging integrated electronic health records (EHRs) with decision support tools to flag eligible patients, simplifying and streamlining the ordering process, while addressing the CMS (Centers for Medicare and Medicaid Services) mandates.
- Centralized screening navigators who partner with PCPs to handle logistics and patient education, coordination, communication, and management of findings.
- Clinical quality incentives tied to preventive care delivery, including cancer screenings. These, even in the absence of a HEDIS measure, can be incorporated into performance measures for providers as well as administrators.
- Outreach and registry tools that can run bulk queries and prompt outreach for patients meeting screening criteria. Registries can enhance quality and facilitate adoption of screening through data assimilation and promotion.
- Shared accountability offers a means for ranking sites and providers within a network to promote healthy competition and performance. These rosters can be system-based, regional, or state-based.
- Nodule Review Boards or Panels which can review suspicious nodules, direct the care, including follow-up imaging, disposition, and specialist referral. This approach ensures care that is most cost effective, time efficient, and at the least risk to the patient. Ideally the same pathways should be set up for lung cancer screening programs and incidental pulmonary nodule programs.
Overall, this model mirrors many of the elements of success seen in colon cancer screening and mammography. Embedding lung screening into the same preventive architecture allows primary care teams to do what they do best—prevent and lessen the impact of disease, not just treat it.
Key Actions to Strengthen PCP Engagement
To unlock the full potential of lung cancer screening through primary care, health systems and public health partners must:
- Educate and Equip: Offer practical CME, quick-reference tools, and sample scripts for shared decision-making. The GO2 for Lung Cancer has such a program offered through their GO2 Global Knowledge Center for Lung Cancer. The National Lung Cancer Round Table (NLCRT) just released a step by step Best Practice Guide for Building Lung Cancer Early Detection Programs – National Lung Cancer Roundtable
- Simplify the Process: Reduce friction in ordering and referring for LDCT. Establish clear, concise pathways.
- Recognize and Incentivize: Reward primary care practices for closing care gaps in lung screening. Highlight top performing sites. Reinforce positive outcomes of early detection by acknowledging responsible providers through staff messages or letters.
- Leverage Team-Based Care: Utilize IT, nurses, MAs, navigators, and pharmacists to assist in patient identification and counseling.
- Promote EHR Integration: Implement automated health maintenance reminders and flagging systems for eligible patients.
A National Priority, A Local Opportunity
From a public health perspective, increasing lung cancer screening uptake is one of the most cost-effective and impactful actions we can take to save lives. Lung cancer screening is the easiest and least invasive screening available for the major cancers.
Every lung cancer found in the early stages is a life potentially saved. And most of these lives will only be found if a primary care provider starts the conversation. Stage I lung cancer can have a greater than 90% chance of cure. Individuals will get to see their children married, their grandchildren born, and attend many more holiday gatherings.
At the Rescue Lung Society, we believe in uniting clinicians, advocates, and health systems around the shared mission of early detection. Primary care networks are not just a referral source, they are the backbone and foundation of population health, and their leadership in lung cancer screening is indispensable.
Let’s empower them, support them, and most importantly—work with them to rescue more lungs, and more lives.
If you’re a primary care provider looking to implement lung cancer screening in your practice, or a system leader interested in building a robust screening infrastructure, the Rescue Lung Society can help. Contact us to learn more about resources, toolkits, and partnerships.
