Opportunities and challenges in lung cancer screening implementation: a narrative review

The U.S. Preventive Services Task Force and the Centers for Medicare and Medicaid Services (CMS) recommend lung cancer screening (LCS) for high risk current and former smokers. Developing a comprehensive LCS program requires coordinated planning from program conception through implementation and maintenance that address both pragmatic and regulatory matters. In this review article, we discuss the available evidence, guideline recommendations, and practical considerations for implementing a high-quality LCS program. Key factors in the initial planning phase include engagement of stakeholders with a particular focus on support from providers, patients and healthcare organizations. Additionally, it is important to consider the infrastructure and program design that will best serve local needs, and implement mandatory components such as a data registry and smoking cessation. We also discuss the implementation phase including strategies for optimizing the eligible patient population to be screened as well as the processes of shared decision making (SDM), standardization of screening results and communication of findings to patients. Once patients have been screened, maintenance of a successful LCS program requires iterative multidisciplinary reviews of key quality metrics and establishing systematic mechanisms to track evaluation, minimizing loss to follow-up. We also review other recommended components that contribute to maintaining a high-quality screening program such as a clinical screening coordinator, patient navigator, and tools to improve the uptake of and adherence to LCS.