Concern with Veterans Health Administration’s Lung Cancer Screening Program Requirements

The VA Office of Inspector General (OIG) conducted a focused review of Veterans Health Administration (VHA) guidelines for lung cancer screening (LCS) and the requirements for a VA facility LCS program. VHA has 10 mandatory elements that must be in place for a facility to establish an LCS program.Lung cancer is the third most diagnosed type of cancer in the United States and is the leading cause of cancer deaths. Lung cancer generally has a poor prognosis, but diagnosis at an early stage improves patients’ survival. The US Preventive Services Task Force first recommended LCS in 2013 and updated the recommendation in 2021. Despite the impact LCS has on improving patients’ survival, LCS rates in the United States remain low.The OIG surveyed facility staff involved in LCS. Facility staff reported that VHA LCS guideline requirements presented barriers to broader adoption of LCS and did not ensure consistent implementation. The most frequently cited barriers by facilities without an LCS program were the absence of an LCS coordinator, the lack of adequate staffing, the absence of a patient registry, and the lack of a multidisciplinary board. The OIG determined just over half of surveyed VHA facilities reported having an established LCS program consistent with VHA guidelines for LCS.In addition, the OIG found that regardless of whether facilities had established a compliant LCS program, variability remained in how facilities identify patients who met LCS criteria. Additionally, methods for interpreting low-dose computed tomography (CT) scans varied among facilities. Ten sites completing low-dose CT scans for lung cancer reported not using an established system for classification of the results.The OIG made three recommendations to the Under Secretary for Health. Recommendations addressed the operational memorandum for LCS implementation and the lack of a requirement to offer eligible patients LCS.