Lung Cancer Screening at a VA Medical Center

SOURCE: Okereke IC, Bates MF, Jankowich MD, et al. Effects of implementation of lung cancer screening at one Veterans Affairs medical center. Chest 2016;150:1023-1029.

Thanks to favorable results from a very large clinical trial of low-dose CT lung cancer screening (n > 53,000) that showed not only a reduction in lung cancer mortality but also all-cause mortality, it is incumbent on clinicians to offer screening to appropriately selected patients. Experience at a VA medical center in Providence, RI, appears to favorably reflect some of the track record of the aforementioned National Lung Screening Trial.

When Okereke et al compared identification of lung nodules in a pre-screening period (2011-2013) to the 2013-2014 screening interval, they noted a distinct “downgrading” of lung cancer staging achieved through screening; that is, prior to screening, 37% of lung cancers were early stage (Stage I or Stage II). During the screening interval, 60% of identified lung cancers were early stage.

The prevalence of smoking usually is higher in VA medical center settings than the general public. Lung cancer screening in this population assists in identifying lung cancer at an earlier, more survivable stage.