The Fourth IASLC Screening Strategy Advice Committee CT Screening Workshop

By John K. Field, PhD, FRCPath, and James L. Mulshine, MD, PhD

The Fourth IASLC Screening Strategy Advice Committee (SSAC) computed tomography (CT) screening workshop was held on December 3, 2016, prior to IASLC WCLC 2016. This workshop provided a comprehensive international forum for all lung cancer clinical specialties to meet and discuss the advances in CT screening trials and imaging technology as well as future implementation plans.

This workshop focused on highimpact issues emerging in the area of lung cancer screening. Foremost among those issues was emphasizing the critical obligation to provide smoking cessation services in the context of lung cancer CT screening programs. This integration of smoking cessation with the provision of lung cancer screening has been termed a “teachable moment” and relates to the high reported success of smoking cessation when offered in the context of lung cancer screening. This integration has been found to result in a significant cost benefit, reducing the overall expense of providing the CT-based screening service. Further discussions addressed additional measures to reduce the cost of delivering this screening service by evolving more efficient clinical screening management approaches. The session also focused on radiological imaging and workup based on the experience of the international screening trials, and provided an overview of the innovative approaches of qualitative imaging quality control for lung cancer screening as well as opportunities for developing data registries. The second session explored opportunities for IASLC to support critical research in this area, such as by creating international registries of CT images/clinical data. The third session highlighted the advances of utilizing of lung cancer CT screening scans for coronary heart disease (CHD) and chronic obstructive pulmonary disease (COPD) within future screening programs. These discussions will focus on the benefits of undertaking screening for the big 3 tobacco-related diseases: lung cancer, CHD, and COPD.

The fourth session provided the opportunity to discuss a global implementation plan for CT screening programs, potentially leveraging US, Canadian, and UK experience to understand how this process can be optimized in other national settings.

The fifth and final session was a roundtable discussion, concentrating on five major questions of:
• Identification of the hard-to-reach community for lung cancer screening
• Use of quantitative imaging in screening setup, and whether accreditation is needed
• CT screening data registries and the possibilities for international collaboration
• The development of international guidelines for the workup of CTdetected nodules
• IASLC’s support of the thoughtful evolution of research to explore the utility of thoracic CT in the asymptomatic assessment of other tobaccorelated conditions in high-risk cohorts

The major aim of the fourth SSAC CT screening workshop was to discuss recommendations to the IASLC as to how they can support leadership in the arena of lung cancer screening globally. This is an ongoing process.