Lung Cancer Screening: Pulmonary Nodules aren’t 8-bit

Written by: Lance Black, Chief Clinical Strategy Officer

Imagine dusting off your Atari 2600 in today’s world of cutting-edge gaming consoles. The initial wave of nostalgia quickly gives way to the reality of clunky gameplay, 8-bit graphics, and monotonous design. It’s not 1977 anymore – we’ve grown accustomed to the high-resolution, immersive experiences that modern gaming provides.

In a similar vein, lung cancer screening is emerging from what might be considered its 'Atari phase.' Formally recommended by the UnitedStates Preventive Services Task Force (USPSTF) since 2013, management guidelines are just now catching up (e.g., Lung-RADS: issued in 2014 [updated in 2019], BTS Guidelines: issued in 2015 [updated in 2020]). Unlike other cancer screenings that have been refined over decades, lung cancer screening is navigating its inaugural decade, attempting to keep pace with rapidly evolving medical standards and technologies. 

Other recommended cancer screenings have had time to evolve, adapt, and better serve populations. Let’s take a quick look back at some of the history of screening recommendations from the USPSTF:

• Pap Smear for cervical cancer screening first recommended in 1980 (44 years ago)
• Mammography for breast cancer screening first recommended in 1989 (35 years ago)
• Colonoscopy for colon cancer screening first recommended in 2002 (22 years ago)
• LDCT for lung cancer screening first recommended in December 2013 (< 11 years ago)

Given this timeline, it is not surprising to discover that only 5-6% of eligible Americans are being screened for lung cancer with LowDose Computed Tomography (LDCT) while other recommendations have achieved adherence rates of 60-70%, sometimes even higher. This lag places lung cancer screening more than three decades behind other cancer screenings - as far behind as Atari is to the Playstation 4. Which would you rather play?

Despite knowing lung cancer screening is in its infancy, the disparity, particularly against the backdrop of other more established cancer screenings, is a source of frustration to patients and providers. Consider colonoscopy: initially, its uptake was gradual due to its invasive nature. Yet, it now boasts screening rates of 63-68%, thanks in part to extensive public health campaigns, enhanced physician engagement, and refined guidelines. Lung cancer screening has not had its chance to explode on the scene, but it’s coming.

What took decades for other cancer screening programs to achieve should be compressed for lung cancer, given the solid foundation laid by its predecessors. In the realm of gaming, we’ve witnessed each console building on its predecessor resulting in ‘accelerating returns’ (i.e.,technology progressing at an exponential rate). Practitioners have the advantage of building lung cancer screening programs based on their learnings and experiences with other cancer screening programs.  As an example, Pulmonary Nodule Clinics equipped with Lung Navigators (sounds like a great Atari game) and organized solely for the management of patients with pulmonary nodules are emerging rapidly in the United States.

The next decade will belong to lung cancer screening with the rapid rise of adherence, formal screening programs at most institutions, and advancing technologies all in support of managing these patients.

 As the medical community continues to push the boundaries, we anticipate a future where lung cancer screening is as commonplace and refined as its breast and colorectal counterparts. In this future, early detection and improved outcomes are not just hopeful goals but tangible realities, saving lives and easing burdens on both patients and the healthcare system. 

The transition from 'Atari to advanced' in lung cancer screening is on the horizon, promising to redefine our approach to this challenging disease in the years to come.