Surgical advocacy in action: The fight for coverage for lung cancer screening

Advocacy by professional societies, patient organizations, coalitions, and individuals has been pivotal to each inflection point in US lung cancer screening policy. After the National Lung Screening Trial that demonstrated a 20% reduction in lung cancer mortality with screening, 2012 guidelines from the National Comprehensive Cancer Network recommended lung cancer screening for individuals at high risk for lung cancer. However, guidelines did not change policy or insurance coverage, and individuals continued to be denied access to early lung cancer detection. In 2012-2014, advocates helped to translate the National Lung Screening Trial evidence into a US Preventive Services Task Force grade B recommendation and a first-ever Medicare national coverage determination that formalized eligibility and quality safeguards. As further experience accrued, the National Comprehensive Cancer Network guidelines evolved, and a second wave of advocacy leveraged new evidence and equity analyses to expand eligibility in the US Preventive Services Task Force recommendation and to modernize Medicare coverage. The National Comprehensive Cancer Network created the first guidelines recommending lung cancer screening and has continued to set the standard of eligibility for others to follow. The National Comprehensive Cancer Network guidelines have helped advocates educate and influence policymakers and have progressively simplified guidelines to help improve access to screening. The American Cancer Society National Lung Cancer Round Table has brought together diverse organizations that have helped further the implementation of early detection but also the full continuum of care for patients with lung cancer. This article synthesizes advocacy mechanisms (public comments, coalition letters, implementation toolkits, and media campaigns) and traces their imprint on policy text and program operations.