What are the criteria of a good lung cancer screening program?
Julian Dobranowski: A good screening program should be based on the results that came through the NLST (National Lung Screening Trial) study to start with, but I think you have to go one step further and try and identify the patients that are at high risk. There is a tool available by one of the key epidemiologists involved with the NLST study which takes a patient-centered approach. By asking a patient questions, you can restratify the patient, you can identify patients that are at higher risk. Based on his model, any patient that has a greater than 2% chance of developing lung cancer in 6 years should have lung cancer screening. That is one valuable component.
The other component is making sure that the radiology community is fully on board. Lung cancer screening is a multidisciplinary approach. Everybody has a role to play and that role has to be providing high-quality tools and outcomes at the far end. The radiologist has to be able to interpret these studies in a standardized way and to refer the patient for further studies or further follow-up also in a very standardized way.