Implementation of a New Screening Recommendation in Health Care: The Veterans Health Administration’s Approach to Lung Cancer Screening

for lung cancer screening with low-dose computed tomog-raphy. The recommendation applies to high-risk adults aged 55 to 80 years with a smoking history of at least 30 pack-years who are still smoking or have quit within the past 15 years (1). The USPSTF based its recommendation on the landmark National Lung Screening Trial (NLST) (2), which provided evidence about the efficacy of screen-ing but did not answer questions about effectiveness when implemented in everyday clinical practice. The recommen-dation, as noted in an accompanying editorial, leaves many of these critical issues unaddressed (3). Indeed, the Medi-care Evidence Development & Coverage Advisory Com-mittee recently concluded that there was inadequate evi-dence to recommend national coverage for lung cancer screening (4). This conclusion highlights the controvers