Group Health’s new lung cancer screening program shows promise

From left: Diana Buist, Jennifer Nazarko, and Karen Wernli.

A project to find early cancers is saving lives, thanks to teamwork, writes Jennifer Nazarko, director of medical specialties

Group Health is a learning health care system. That means that our clinical and research sides work together on quality improvement programs that benefit clinicians and staff and especially patients and families. Here's a recent example.

For over a year, I've been part of a team of Group Health providers and Group Health Research Institute (GHRI) scientists studying the adoption of a new lung cancer screening program for members of our health care system. Lung cancer is the leading cause of cancer death in the United States. If detected early, most lung cancers can be successfully treated, for example with surgery. Until recently, though, we haven’t had a good early detection system for this type of cancer.

We now have results from the National Lung Cancer Screening Trial (NLST), which compared low-dose computed tomography (LDCT) to regular x-rays for detecting lung cancer. The trial found that LDCT reduced lung cancer deaths in people at high-risk for this disease. In 2015, LDCT screening became a recommended strategy for screening people with a smoking history and age that puts them at high risk for lung cancer.

The Group Health lung cancer screening program is based on the NLST. It is designed to find lung cancers when treatment has the best chance of success. The challenge with LDCT for lung cancer is that it often finds unusual features in lungs that are not dangerous. We don't want people to go through diagnostic tests and cancer treatment for something that is not life threatening, so LDCT is recommended only for people at the highest risk for lung cancer. They are most likely to get lung cancer so they benefit the most from screening. We know who those people are: heavy and long-term smokers. That’s why Group Health started offering LDCT screening last year to members at high risk of lung cancer. The process begins with a shared decision-making conversation with a doctor. 

Our first results on LDCT for lung cancer

I'm pleased to report on behalf of the LDCT team that our first results are in and they are excellent. As of December 2015, we have screened about 630 people. We match the national trial results in detecting cancers. Our preliminary results can't tell us yet if the screening reduced deaths from lung cancer overall in the people who were screened. However, we detected several previously undetected malignancies and we believe at least three people likely had their life saved because of this program.

This has been a team effort. For health care systems, LDCT screening is complicated because it involves people from many clinical areas. At Group Health, pulmonary, radiology, family medicine, oncology, clinical informatics, and preventive medicine representatives have all worked together to be sure at-risk patients are offered screening and those with positive LDCT tests get follow-up appointments.

Come to our seminar to hear more

Our evaluation work, funded by the GHRI Development Fund, shows how Group Health and GHRI can collaborate to improve care and save lives. Across the country, other health care organizations are creating their own LDCT programs. Our project is a leading example for them. If you are a Group Health member interested in this program, please contact your primary care physician about your risk for lung cancer.

If you'd like to hear more, please come to our seminar on January 12, 4:00 p.m. at GHRI in Seattle. We'll give details about our results and talk about what we're going to do next.

by Jennifer Nazarko, FACHE, Group Health director of medical specialties

Group Health Lung Cancer Screening Guideline team

David Grossman, MD, MPH; Avra Cohen, MN; Fred Brodsky, MD; Eric Chen, MD; Peter Chuang, MD; Matt Fei, MD; Quinn Jenkins, MPH; Robert Karl, MD; Sarah Levy, MD; Priscilla Madsen, MD; Robyn Mayfield; Marcy Parsons; Ann Stedronsky; Carolyn Wild, MD; Bette Drescher; Johanne Leblanc, MD.

Group Health Lung Cancer Screening Implementation team leaders

Robert Winter; Genevieve McGrann, RN; Julia Beatty, RN; Sarah Jablonski, RN; Kelli Lynch; Bette Drescher; Johanne Leblanc, MD.

GHRI Lung Cancer Screening Evaluation team

Diana Buist, PhD; Karen Wernli, PhD; Susan Brandzel, MPH; Roy Pardee, JD; Hongyuan Gao, MS.