The Centers for Medicare & Medicaid Services (CMS) announced plans to pay for lung cancer screening for people who are at high risk of developing the disease. The decision comes after the U.S. Preventive Services Task Force (USPSTF) recommended that people 55 years or older who have a history of smoking should be screened annually for lung cancer based on a study showing early detection of the disease resulted in a major drop in mortality.
“This is an important decision by CMS that has the potential to significantly reduce death due to lung cancer,” says Martin J. Edelman, MD, FACP professor of medicine at the University of Maryland School of Medicine and head of the Section of Solid Tumor Oncology at the University of Maryland Greenebaum Cancer Center.
Lung cancer is the leading cause of cancer death in the United States, exceeding the cumulative number of deaths from breast, colon and prostate cancer. Smoking is the number one risk factor for lung cancer and has been linked to about 90 percent of cases in this country. Patients often don’t show symptoms of the disease until it’s progressed to an advanced and inoperable state.
Under the proposed plan, Medicare will cover the cost of annual low-dose CT screenings for individuals age 55-74 who have a smoking history of at least 30 packs per year, are either current smokers or have quit within the last 15 years, and have no symptoms of lung disease. The plan is in a 30-day comment period and is expected to be approved.
Medicare’s recent decision to cover lung cancer screening in this high-risk population is in line with that of several private insurers. The industry’s shifted focus on the importance of early detection is tied to results of the National Lung Screening Trial (NLST), which demonstrated that screening with low dose CT (computed tomography) scans reduced lung cancer mortality by 20 percent and overall mortality by 7 percent in people at high risk for the disease.
“The NLST study is the first time we’ve been able to show that kind of reduction for lung cancer mortality through screening,” says Charles White, MD, professor of diagnostic radiology at the UM School of Medicine and director of Thoracic Imaging and vice-chairman for Clinical Affairs at the University of Maryland Medical Center (UMMC). “The advantage is that we can detect cancer at an earlier stage and actually save lives.”
A 2012 actuarial study that looked at the costs and benefits of annual lung cancer screening showed that, with the number of lives saved through early detection, the cost per life-year saved is lower than that of breast or cervical cancer screening.
While increased screening rates may reduce the lung cancer mortality, there is a potential downside that will need to be managed.
“There is a significant problem with false positive screens—in other words, the detection of abnormalities that are not cancer but require further scans or diagnostic procedures,” says Dr. Edelman, who is a member of the Endpoint Verification Committee for the NLST. “Given this number, it is critical that screening be done as part of an organized program at institutions with significant radiological, pulmonary and surgical capabilities and not on an ad hoc basis. It is also critical that a screening program include smoking cessation as part of the effort.”
In order to participate in CMS-covered screenings, radiologists and screening facilities must meet certain criteria, including training in low dose CT screenings for lung cancer.
At the Greenebaum Cancer Center, medical, surgical and radiation oncologists work with diagnostic radiology and pulmonology as a multidisciplinary team to screen for, diagnose and treat lung cancer.
“At Maryland we have a very comprehensive lung program,” says Dr. White. “In radiology alone we have six physicians who work with chest CT scans. We conduct a lot of lung imaging and try to reduce the dose as much as possible, which is one of the concerns with doing chest CT scans.”
Video: Dr. Charles White explains National Lung Cancer Screening Trial results.
Source: Medicare to Cover Lung Cancer Screening for High-risk Patients