Implications of lung cancer screening - complexity and policy

Saturday, February 4, 2017

Recently (January 30, 2017) a large group led by Linda Kinsinger, MD, DGIM adjunct professor, and senior author, George Jackson, PhD, DGIM Associate Professor, published an Online First in JAMA Internal Medicine — “Implementation of Lung Cancer Screening in the Veterans Health Administration.” These researchers showed that the implementation of a comprehensive lung cancer screening program in the Veterans Health Association (VHA) will require significant clinical effort with uncertain patient benefit.

In the end, this evaluation found that while lung cancer screening can help to identify lung cancer, there are also challenges.  These include:

  • identifying patients to be screened
  • communicating effectively the risks and benefits of screening to patients
  • helping patients interpret results
  • ensuring that patients going through the screening process get all needed services
  • coordinating clinical specialties 

Promise of informatics

While challenging, resources such as dedicated lung cancer screening coordinators and information systems that can help track patients through the screening process hold promise for maximizing the effectiveness of population-based lung cancer screening

"This paper represents the role of utilizing health services research and implementation science as part of a learning health system," says senior author, Dr. George Jackson.

"This paper represents the role of utilizing health services research and implementation science as part of a learning health system."

Eight research locations and a range of methodologic expertise

The VA National Center for Health Promotion and Disease Prevention led the implementation of lung cancer screening at eight sites and the Durham Health Services Research and Development Center of Innovation conducted a comprehensive evaluation of the clinical results, economic impact, and implementation realities of the program.  This information is being used by the VA to make decisions about the future of how to best implement lung cancer screening.

This project demonstrates a broad range of methodologic expertise within the Division of General Internal Medicine and Durham VA HSR&D Center, including health services research, implementation science, clinical epidemiology, qualitative research, health economics, and biostatistics.  The evaluation was a team effort across Ph.D. and physician scientists with a variety of methodologic skills.

The evaluation of the Lung Cancer Screening Demonstration Project is one of many examples where DGIM, Department of Medicine, and VA HSR&D faculty have partnered with health system operations to inform practical decision making with methodologically rigorous research and evaluation.

This study reflects the teams’ ability to study and understand the results from the perspective of a national health system and a national health policy.


Kinsinger LS, Anderson C, Kim J, Larson M, Chan SH, King, HA, Rice, KL, Slatore, CG, Tanner, NT, Pittman, K, Monte RJ, McNeil RB, Grubber JM, Kelley MJ, Provenzale D, Datta SK, Sperber NS, Barnes LK, Abbott DH, Sims KJ, Whitely RL, Wu R, Jackson GL. Implementation of Lung Cancer Screening in the Veterans Health Administration. January 30 2017. JAMA Intern Med. 2017; PMID: 28135352 [Link] [Editorial]