The Role of the Advanced Practitioner in a Comprehensive Lung Cancer Screening and Pulmonary Nodule Program

Authors' disclosures of potential conflicts of interest are found at the end of this article. T he focus of many cancer centers has been primarily on the diagnosis and treatment of disease. While advancing treatments is important , prevention and early detection of disease needs to be formally integrated into comprehensive cancer cancers. It is the mission of the American Cancer Society to prevent and detect cancer early (Ameri-can Cancer Society [ACS], 2008). Screening is the essential modality in achieving this mission. It is estimated that more than half of all cancer cases worldwide can be prevented or detected early by screening (ACS, 2011). Effective screening tools reduce cancer mortality and influence cancer-specific survival rates. For decades, screening has been beneficial in early detection of breast, cervical, prostate, and colorectal cancers. Lung cancer, the leading cause of cancer death in both men and women, has not had the benefit of a screening modality ; this is partially reflected in the poor 5-year survival rate of 16.6% (ACS, 2013; Howlader et al., 2013). When lung cancer is detected at an early stage and localized, the 5-year survival rate increases to 53.5% (Howlader et al., 2013). In 2011, the results of the National Lung Cancer Screening Trial (NLST) transformed the early detection of lung cancer with the demonstration of a mortality benefit related to screening with low-dose computed tomography (LDCT; Aberle et al., 2011). Lung cancer screening is based on decades of clinical research. Prior randomized screening studies utilizing chest radiographs and sputum cytology proved insufficient to demonstrate a reduction in lung cancer mortality, the gold standard outcome of a screening tool (Oken et al., 2011; Marcus et al., 2000; Hock-ing et al., 2010). The NLST, a multi-institutional study sponsored by the National Cancer Institute (NCI), demonstrated for the first time that