Veterans Health Administration National Center for Health Promotion and Disease Prevention, Durham, North Carolina.
Veterans Health Administration National Radiology Program Office, Durham, North Carolina.
JAMA Intern Med. 2017 Mar 1;177(3):399-406. doi: 10.1001/jamainternmed.2016.9022.
The US Preventive Services Task Force recommends annual lung cancer screening (LCS) with low-dose computed tomography for current and former heavy smokers aged 55 to 80 years. There is little published experience regarding implementing this recommendation in clinical practice.
To describe organizational- and patient-level experiences with implementing an LCS program in selected Veterans Health Administration (VHA) hospitals and to estimate the number of VHA patients who may be candidates for LCS.
DESIGN, SETTING, AND PARTICIPANTS: This clinical demonstration project was conducted at 8 academic VHA hospitals among 93 033 primary care patients who were assessed on screening criteria; 2106 patients underwent LCS between July 1, 2013, and June 30, 2015.
Implementation Guide and support, full-time LCS coordinators, electronic tools, tracking database, patient education materials, and radiologic and nodule follow-up guidelines.
Description of implementation processes; percentages of patients who agreed to undergo LCS, had positive findings on results of low-dose computed tomographic scans (nodules to be tracked or suspicious findings), were found to have lung cancer, or had incidental findings; and estimated number of VHA patients who met the criteria for LCS.
Of the 4246 patients who met the criteria for LCS, 2452 (57.7%) agreed to undergo screening and 2106 (2028 men and 78 women; mean [SD] age, 64.9 [5.1] years) underwent LCS. Wide variation in processes and patient experiences occurred among the 8 sites. Of the 2106 patients screened, 1257 (59.7%) had nodules; 1184 of these patients (56.2%) required tracking, 42 (2.0%) required further evaluation but the findings were not cancer, and 31 (1.5%) had lung cancer. A variety of incidental findings, such as emphysema, other pulmonary abnormalities, and coronary artery calcification, were noted on the scans of 857 patients (40.7%).
It is estimated that nearly 900 000 of a population of 6.7 million VHA patients met the criteria for LCS. Implementation of LCS in the VHA will likely lead to large numbers of patients eligible for LCS and will require substantial clinical effort for both patients and staff.
美国预防服务工作组建议，为年龄在 55 岁至 80 岁的当前和曾经的重度吸烟者，每年进行一次低剂量计算机断层扫描肺癌筛查（LCS）。在临床实践中实施这一建议的经验很少。
描述在选定的退伍军人健康管理局（VHA）医院实施 LCS 计划的组织和患者层面的经验，并估计可能适合 LCS 的 VHA 患者数量。
设计、地点和参与者：这项临床示范项目在 8 家学术性 VHA 医院的 93033 名初级保健患者中进行，这些患者根据筛查标准进行评估；2106 名患者于 2013 年 7 月 1 日至 2015 年 6 月 30 日进行了 LCS。
实施指南和支持、全职 LCS 协调员、电子工具、跟踪数据库、患者教育材料以及放射学和结节随访指南。
描述实施过程；同意进行 LCS 的患者比例、低剂量计算机断层扫描结果阳性（需要跟踪的结节或可疑发现）的患者比例、发现肺癌的患者比例或偶然发现的患者比例；以及符合 LCS 标准的 VHA 患者数量的估计值。
在符合 LCS 标准的 4246 名患者中，有 2452 名（57.7%）同意进行筛查，有 2106 名（2028 名男性和 78 名女性；平均[SD]年龄 64.9[5.1]岁）进行了 LCS。8 个地点的过程和患者体验存在广泛差异。在 2106 名接受筛查的患者中，有 1257 名（59.7%）有结节；其中 1184 名患者（56.2%）需要跟踪，42 名（2.0%）需要进一步评估但发现不是癌症，31 名（1.5%）患有肺癌。在 857 名患者（40.7%）的扫描中发现了各种偶然发现，如肺气肿、其他肺部异常和冠状动脉钙化。
据估计，在 670 万 VHA 患者的人群中，近 90 万人符合 LCS 的标准。在 VHA 中实施 LCS 可能会使大量患者符合 LCS 标准，这将需要患者和工作人员的大量临床努力。
