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Editorials: Point and Counterpoint |

Rebuttal From Dr Powell FREE TO VIEW

Charles A. Powell, MD, FCCP
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURE: The author has reported to CHEST the following: C. A. P. served as a consultant to Siemens, Inc.

Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY

CORRESPONDENCE TO: Charles A. Powell, MD, FCCP, Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai–National Jewish Health Respiratory Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, Box 1232, New York, NY 10032


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(6):1218-1219. doi:10.1016/j.chest.2016.11.053
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Dr Goodson convincingly establishes the importance of integrating screening services within an ongoing comprehensive provider-patient relationship that continuously evaluates and prioritizes the provision of screening services while taking into account patients’ comorbidities, values, and preferences. It is an attractive proposition that represents a preferred approach for key steps of the lung cancer screening process that include assessment of eligibility and performance of a shared medical decision-making visit.

However, exclusive implementation of an approach that restricts lung cancer screening referrals to only primary care providers would require universal access to primary care providers with sufficient knowledge and expertise in cancer screening services. At present, access and education are not sufficient to support this exclusive approach. I agree with Dr Goodson that messaging about screening must be consistently delivered by all physicians regardless of specialty. We should advocate for primary care providers and other specialists to partner with qualified lung cancer screening programs that provide education and infrastructure that facilitates primary care referrals, provides direct access to shared decision-making visits, and helps to coordinate follow-up management for patients. The American College of Chest Physicians/American Thoracic Society policy statement on lung cancer screening outlines criteria that define a high-quality screening program. An inclusive approach that integrates existing patient-provider relationships with resources provided by qualified lung cancer screening programs offers the best opportunity to realize the promise of chest CT screening to reduce lung cancer mortality.

References

Goodson J.D. . Point: Should only primary care physicians provide shared decision-making services to discuss the risks/benefits of a low-dose chest CT scan for lung cancer screening? Yes. Chest. 2017;151:1213-1215 [PubMed]journal
 
Mazzone P. .Powell C.A. .Arenberg D. .et al Components necessary for high-quality lung cancer screening: American College of Chest Physicians and American Thoracic Society Policy statement. Chest. 2015;147:295-303 [PubMed]journal. [CrossRef] [PubMed]
 

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References

Goodson J.D. . Point: Should only primary care physicians provide shared decision-making services to discuss the risks/benefits of a low-dose chest CT scan for lung cancer screening? Yes. Chest. 2017;151:1213-1215 [PubMed]journal
 
Mazzone P. .Powell C.A. .Arenberg D. .et al Components necessary for high-quality lung cancer screening: American College of Chest Physicians and American Thoracic Society Policy statement. Chest. 2015;147:295-303 [PubMed]journal. [CrossRef] [PubMed]
 
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