Lung Cancer Screening and (New) Recommendations

When it comes to cancer, lung cancer leads the list of the most deadly for men and women in the US. Fighting this disease has been an uphill battle, impeded by the fact that most patients are not diagnosed until late in their disease. Having an effective screening test to identify lung cancer when it is small and treatable has been a goal for years – the development of low-dose CT chest for the screening for lung cancer has brought hope.  

We are therefore profoundly disappointed that the Centers for Medicare & Medicaid Services (CMS)’s Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) did not vote to recommend Medicare coverage of low-dose CT screening. Their primary concern is not that is does not find cancer, but that it will find too many things that are not cancer.  

We disagree with the CMS, as do other (more important!) groups in the US. The United States Preventative Services Task Force (their statement can be found here) recently recommended coverage. This is critical, as those preventive services deemed appropriate by the Task Force are mandated to be covered under the Affordable Care Act. What does that mean? A double standard – those with health insurance will be covered, those with Medicare will not if the CMS acts on the recommendations of their advisory committee.  

One of the (many!) advocates of low-dose CT screening is the American College of Radiology (their statement can be found here). The ACR supports the use of screening CT chests in those patients at the highest risk – in other words, heavy smokers or heavy former smokers. The National Lung Screening Trial found that there was a 20% reduction in deaths for heavy smokers due to screening (the trial report can be found here). That’s no small number. The ACR is working on developing uniform guidelines to help with interpretation and to reduce the number of false findings – those that seemed to concern the Advisory Committee.  

Luckily, the CMS is not bound by the recommendations of MEDCAC and action based on the recommendation isn’t expected until late fall of this year. We hope that reevaluation of the data occurs between now and then, so that Medicare patients are covered.  

If you’d like to know more about lung cancer and what you can do about it, we recommend checking out Free to Breathe. Eliminating the use of tobacco is a larger goal which will more profoundly affect lung cancer in the US – if you smoke, get help to stop.

Imagine attribution: smoking kills by André Hengst via Flickr Copyright Creative Commons Attribution-NonCommercial-ShareAlike 2.0 Generic (CC BY-NC-SA 2.0)

Originally published 5/1/14 on diagnosticimagingcenterskc.com.