Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

What is the comparative effectiveness of imaging techniques [and strategies] for the screening of lung cancer among high risk as well as the general population.

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Diagnostic CT scans and chest X-ray, tomosynthesis, FDG-PET.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

This questions applies to both the general population as well as patients more at risk for lung cancer, such as those with a history of tobacco use or occupational exposure to carcinogenic materials.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

See above.

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Improved outcomes due to earlier detection of cancer.

Describe any health-related risks, side effects, or harms that you are concerned about.

Imaging techniques such as those suggested above increase radiation exposure. A screening program, especially in the general population, also introduces the risk of over-diagnosis and false positives leading to unnecessary follow-up testing including further imaging tests and invasive biopsies.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Cancer

AHRQ Priority Populations

• Low income groups
• Minority groups

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

Lung cancer is the leading cause of cancer deaths in the U.S. Part of its high mortality is due to the often late stage of disease at the time of diagnosis. Effective screening programs may allow lung cancers to be detected at earlier, more treatable stages of the disease. This question may also help define in which populations screening could be of benefit.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

THIS TOPIC WAS RECOMMENDED BY A DIVERSE PANEL OF STAKEHOLDERS AS A HIGH PRIORITY QUESTION FOR AN EVIDENCE REVIEW.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

There are currently a number of studies, including the recent National Lung Screening Trial, looking at this question, but the effectiveness of screening in different populations, and use of different imaging modalities, is still uncertain.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

THE ANSWER TO THIS RESEARCH QUESTION WILL BE DISSEMINATED BY THE EFFECTIVE HEALTH CARE PROGRAM TO CLINICAL PROVIDERS AND POLICY MAKERS WHO WILL USE THE INFORMATION TO MAKE INFORMED TREATMENT AND COVERAGE DECISIONS.

Describe the timeframe in which an answer to your question is needed.

AS SOON AS POSSIBLE TO BETTER INFORM STAKEHOLDERS.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Socioeconomically disadvantaged and minority populations are at increased risk of lung cancer due to increased prevalence of smoking in these populations.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

THE ANSWER TO THIS RESEARCH QUESTION WILL BE DISSEMINATED BY THE EFFECTIVE HEALTH CARE PROGRAM TO CLINICAL PROVIDERS AND POLICY MAKERS WHO WILL USE THE INFORMATION TO MAKE INFORMED TREATMENT AND COVERAGE DECISIONS.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program