USPSTF Lung cancer screening guidelines

[deleted1053216]

Hello,
So I need some guidance here, I have had a number of pt.s who fall 50-80, are smoking, but the way they report it, I smoke one or two cigarettes occasionally. In a month twice or last time I smoked a cigarette last July. Do these pt.s still get a low dose CT scan and what exactly is a low dose CT scan (CT w/o contrast)?

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[deleted87716]

https://www.acr.org/Clinical-Resources/Lung-Cancer-Screening-Resources/FAQ

 

[chudat]

Hello,
So I need some guidance here, I have had a number of pt.s who fall 50-80, are smoking, but the way they report it, I smoke one or two cigarettes occasionally. In a month twice or last time I smoked a cigarette last July. Do these pt.s still get a low dose CT scan and what exactly is a low dose CT scan (CT w/o contrast)?

Ct w/o contrast but even less kvp and ma to reduce dose.... idea is that these pt can get continued screening without significant accumulation of radiation. Every institution should have their own low dose protocol.

 

[Bacchus]

Our LDCT for this is equal to 2 hip XRs per radiology. For calculating pack years, especially my borderline patients I ask them when they started smoking, what their maximum PPD was and keep it that simple. You can’t tell me the risk for a 50yr, 1/2 PPD smoker is statistically much smaller than 1 PPD for 30yr.

 

[FrustratedFamDoc]

If they meet the minimum age criteria, I order no matter what. Let scheduling and insurance sort em out. I'd much rather be accused of overutilizing this awesomely valuable tool than under. In the last year, I've caught 5 NSCLCs, (3 early, 2 late) in otherwise asymptomatic people. It is by far, my most productive cancer screening tool.

 

[B1GM0N3Y86]

Hello,
So I need some guidance here, I have had a number of pt.s who fall 50-80, are smoking, but the way they report it, I smoke one or two cigarettes occasionally. In a month twice or last time I smoked a cigarette last July. Do these pt.s still get a low dose CT scan and what exactly is a low dose CT scan (CT w/o contrast)?

New USPSTF Guidelines as of 2020
- Annual screening with low-dose CT in adults ages 50-80 who have a 20 pack-year smoking history and who currently smoke or have quit smoking within the past 15 years. (vs older one of 30 pack years and not starting till 55)

I offer it to everyone that meets criteria. Need to inform them that its not very useful to only to the scan once and that its needed to track progress of nodules found. Advise them that about 50% have nodules, and over 90 or 95%% of the nodules found are benign.

Informing them of this prior to ordering helps them do the screening as well as less time spent counseling when they get the nodules found since they understand nodules found are common.

 

[hsk013]

I always wondered about this, too, because I've never seen any of my FM preceptors ordering or even suggesting in their outpatient clinic. All my preceptors downplayed and gave some bs excuses when I asked. My dad is an ex-smoker, so I'm a proponent of this and forcing my dad to get this next week. It will be interesting to see how his PCP will respond. But yeah, I feel like this is 1 USPSTF guideline that none of my preceptors followed.

 

[Keona]

New USPSTF Guidelines as of 2020
- Annual screening with low-dose CT in adults ages 50-80 who have a 20 pack-year smoking history and who currently smoke or have quit smoking within the past 15 years. (vs older one of 30 pack years and not starting till 55)

I offer it to everyone that meets criteria. Need to inform them that its not very useful to only to the scan once and that its needed to track progress of nodules found. Advise them that about 50% have nodules, and over 90 or 95%% of the nodules found are benign.

Informing them of this prior to ordering helps them do the screening as well as less time spent counseling when they get the nodules found since they understand nodules found are common.

Any issues with insurances paying for it? Our hospital says they won’t if patient is over 77.

 

[B1GM0N3Y86]

Any issues with insurances paying for it? Our hospital says they won’t if patient is over 77.

I haven't had anything pop back on me yet, but then again I don't recall ordering it yet for someone 78, 79, or 80 yet. I've noticed that for those in their 70s, if they haven't started screening yet, they normally defer this screening.

 

[B1GM0N3Y86]

I always wondered about this, too, because I've never seen any of my FM preceptors ordering or even suggesting in their outpatient clinic. All my preceptors downplayed and gave some bs excuses when I asked. My dad is an ex-smoker, so I'm a proponent of this and forcing my dad to get this next week. It will be interesting to see how his PCP will respond. But yeah, I feel like this is 1 USPSTF guideline that none of my preceptors followed.

Sorry to hear this in regards to the preceptors. Our residency really hammered screening and vaccination guidelines in our heads.

 

[Keona]

I haven't had anything pop back on me yet, but then again I don't recall ordering it yet for someone 78, 79, or 80 yet. I've noticed that for those in their 70s, if they haven't started screening yet, they normally defer this screening.

I tried to order it on several. I just started practice two years ago and took over from someone who was doing annual chest X-rays instead....

 

[B1GM0N3Y86]

I tried to order it on several. I just started practice two years ago and took over from someone who was doing annual chest X-rays instead....

Oh gosh, cxr lol...

 

[Keona]

Update got a note back from a pulmonologist recommending “first and only ldct scan as patient will be 77”