On February 5, 2015, the Centers for Medicare & Medicaid Services (CMS) announced a national coverage determination to include a counseling session and screening for lung cancer with low-dose computed tomography (also known as low-dose CT scan) effective immediately. This coverage includes annual screening for Medicare beneficiaries who meet all of the following:
- Are ages 55 to 77 who are current smokers or quit smoking within the past 15 years.
- Possess a history of tobacco smoking of at least 30 packs per year.
- Have received an order from their health care provider meeting certain requirements.
Coverage includes a visit with a health care provider for counseling to discuss the benefits and risks of lung cancer screening. Previously, those interested in obtaining the lung cancer screening paid approximately $200 for the CT scan.
Benefits for the screening include:
- Early-stage detection.
- An increase in smoking cessation when screening illuminates an abnormal result.
Risks for the screening include:
- Overdiagnosis (biopsies or other surgical interventions of benign abnormalities).
- A high rate of false-positive results (i.e., abnormal results representing benign lesions).
- Undue patient anxiety and cost of additional testing for the above.
- Radiation from repeated low-dose CT scans may increase the risk of cancer.
The Centers for Disease Control and Prevention recommends stopping annual screening for lung cancer when a person meets one or all of the below criteria:
- Turns 81 year old.
- Has not smoked in 15 years.
- Develops a health problem making surgery or other interventions not possible if lung cancer is found.
There is an experimental, noninvasive blood test being studied analyzing molecules called microRNA which may determine if abnormal low-dose CT scan findings are truly lung cancer. In a recent study, the combination of this microRNA blood test with the low-dose CT screening scan for lung cancer resulted in a five-fold reduction of false-positives (reduction from 19.5% to 3.7%).
In 2011, researchers from the National Lung Screening Trial (NLST) demonstrated the prevention of one death in 320 people screened. However, other studies’ models predicted 497 deaths would be averted and 5,250 life-years gained per 100,000 people screened for lung cancer.
Screenings are recommended to be conducted at imaging centers of excellence. To find an imaging center in your area, you can search the Lung Cancer Alliance website.
There are also approved imaging centers for lung cancer screenings through the American College of Radiology
This determination of coverage is vital and appropriate considering lung cancer is the leading cause of cancer-related deaths among both men and women. And as seen in other cancers, notable improvements in survival rates for cancer may be due to earlier detection and/or advances in treatment.
This year, the American Cancer Society predicts there will be approximately 221,000 new cases of lung cancer diagnosed (out of an estimated 1.6 million cases of all new cancers diagnosed) and approximately 158,000 lung cancer-associated deaths in the United States.
What makes the diagnosis and subsequent treatment so elusive for lung cancer is the fact that only 25% of patients find out they have lung cancer in an early stage with no noticeable symptoms—most early-stage detection is incidental. If found early, there is a 57% chance of a 5-year survival rate. Approximately 75% of patients with lung cancer present with symptoms due to advanced local or metastatic disease that is not fully amenable to treatment and/or cure. Despite recent advances in therapy, the 5-year survival rate averages approximately 16% for all individuals with lung cancer.
Are you finding more lung cancer patients being diagnosed in earlier stages with the new screening recommendation?