Kick Butts and the USPSTF 5 A’s Framework

Kick Butts Day is a national day of activism to empower youth to stand up, speak out and seize control against Big Tobacco. Kick Butts Day aims to:


  1. Raise awareness of the problem of tobacco use.
  2. Encourage youth to reject the tobacco industry’s deceptive marketing and stay tobacco-free.
  3. Urge elected officials to take action to protect kids from tobacco.


This Kick Butts Day, Eon decided to examine the prevalence of smoking in the United States, the effect on our communities, and to learn more about smoking cessation. Below is a summary of our findings.


  1. Cigarette smoking is the leading preventable cause of morbidity and mortality worldwide, responsible for over 6 million deaths annually (1).
  2. Smokers who quit smoking reduce their risk of developing and dying from tobacco-related diseases such as cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis.
  3. Despite declining smoking rates in the United States, more than 30 million people, or 14.1% of U.S. adults, smoked in 2017 (2).
  4. Annually, one in five U.S. deaths are attributed to cigarette smoking or secondhand smoke exposure (3).
  5. On average, smokers die 10 years earlier than nonsmokers (4).
  6. Economically speaking, smoking costs the United States over $300 billion each year – $170 billion for direct medical care and over $156 billion in lost productivity from premature death and exposure to secondhand smoke (5).
  7. Despite the known risks of smoking, everyday almost 2,000 young adults under the age of 18 smoke their first cigarette (3).


Ironically, big tobacco still spends more than $1 million every hour advertising and promoting cigarettes and smokeless tobacco products (6). Tobacco companies are having to redefine themselves as cigarette smoking has steadily declined and are heavily investing in Modified Risk Tobacco Products (MRTP). In 2016, André Calantzopoulos, CEO of tobacco giant Philip Morris, said he hoped cigarettes would soon be history, a spurious way to say there are no efforts to reduce nicotine addiction and the company is looking to replace cigarette sales with new nicotine alternatives.


Nearly seven in ten (68%) adult smokers want to quit smoking, while more than half of all adult smokers have made some type of quit attempt (7). So why aren’t more smokers successful at quitting? As it turns out, there is much more to it than just quitting.


One of the biggest challenges around smoking cessation is the relatively low rate of sustained success and researchers are just starting to understand the science behind stopping. Tobacco use of any kind can be characterized as a chronic relapsing substance use disorder that is sustained by addiction to nicotine. According to Martin J. Jarvis at the University College of London, “Social, economic, personal, and political influences all play an important part in determining patterns of smoking prevalence and cessation. Although drug effects underpin the behavior, family and wider social influences are often critical in determining who starts smoking, who gives up, and who continues (8).”


Successful interventions begin with identifying nicotine users and appropriate therapies. For providers, the United States Preventive Services Task Force (USPSTF) recommends the “5 A’s Framework”:


  1. Ask every patient about tobacco use
  2. Advise all users to quit
  3. Assess willingness to quit
  4. Assist with attempts to quit
  5. Arrange follow-up


In fact, the Centers for Medicare & Medicaid Services (CMS) now requires all eligible lung cancer screening patients to be offered smoking cessation prior to having a screening exam.


The Centers for Disease Control and Prevention’s Million Hearts offers a Tobacco Cessation Protocol that can be adopted by health systems and providers to use with tobacco dependent patients. The protocol includes a decision tree for intervention and a Quit Plan checklist.  Tobacco Cessation Protocol.


The 5 A’s Framework and identifying nicotine dependent patients has led to an entirely new discipline in healthcare around smoking cessation. As it is, the family doctor who says “you should stop smoking” is not a very successful cessation tool.  What has been found to be successful is a combination of methods and appropriate interventions based upon the user’s willingness to quit. Such methods include:



Whether you are a physician looking to start a smoking cessation program or a person looking for tools to help a friend stop smoking, this Kick Butts Day join the effort to stand up, speak out, and seize control against big tobacco.





The American College of Radiology has recently made changes to the Lung Cancer Screening Registry (LCSR) data codebook and has released these changes as Version 1.2. Here’s a quick guide to the changes.




The most recent changes were made to Version 1.2 of the LCSR on February 18, 2019. After September 30, 2019, Versions 1.0 and 1.1 of LCSR will no longer be accepted.


Overview of Changes


The reason for this recall was to add an “unable to complete” descriptor and a free text field for CT Exam Results by Lung-RADS. Free-text fields were added to several other areas, including Cancer-related history and Occupational exposure to agents that are identified specifically as carcinogens targeting the lungs. Here’s a list of recent changes, and the date each was released.



Date Version 1.2. Changes

Added a new field ‘AJCC Cancer Staging Manual edition used for staging’.

Added a new field ‘Lung-RADS version used to report results’.

Added a new field ‘Cancer history, other cancer, specify’ (the field is required if  ‘other cancer’ is selected for ‘Cancer related history’).

Added “other, specify” checkbox for ‘Occupational exposures to agents that are identified specifically as carcinogens targeting the lungs’  and free text field in case of selection of the checkbox.

Added new value ‘unable to complete’ for ‘CT Exam Results By Lung-RADS Category’ and free text field to specify.

Added optional follow-up field ‘Follow Up Unique ID’.

Added new values IA1, IA2, IA3, IIIC, IVA, IVB for ‘Overall stage’.

Added new values T1mi, T1c for ‘T-status’.


Added new value Tis for ‘T Status’

Added new value 0 for ‘Overall Stage’

1/18/2019 Updated ‘Number of packs-year of smoking’ valid range from “0 to 999” to “0.1 to 999.9”
1/18/2019 Updated ‘Number of years since quit’ valid range from “0 to 9” to “0.1 to 99.9”
2/18/2019 Added ‘0-Unknown’ value to Ordering practitioner NPI, CTDIvol, DLP and Reconstructed image width

For additional information on LCSR file specifications, please visit the National Radiology Data Registry Support page.


Eon Has Your Back

Eon’s LCSR one-click data submission software includes NRDR confirmation of accepted data. This means you never have to guess if your ACR/CMS required LCSR data submission was accepted. And if for some reason information is incorrectly entered, Eon EPM will always report the proper error.


Specifically, our Validator will validate the following:


  1. JSON syntax
  2. Required fields
  3. Response value of the data elements based on the business rules stated in the LCSR Web


Service Data elements ACR_draft.xlsx.


Eon is committed to ensuring Eon EPM clients are submitting data in the most up-to-date format and will always incorporate new LCSR codebook changes as quickly as possible.


If you have questions about this LCSR release, you can submit them online at If you are interested in learning how Eon EPM simplifies lung cancer screening management and data submission to the LCSR, please visit