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A New Age of Lung Cancer Screening Begins in 2015
By Jim Knaub
The Centers for Medicare & Medicaid Services’ (CMS) recent proposal to cover low-dose CT (LDCT) lung screening would eliminate the age-based coverage discrepancy that would kick in 2015, when the Affordable Care Act’s (ACA) mandated coverage begins for certain smokers and former smokers at high risk for lung cancer.
The ACA did not require Medicare to cover LDCT for American seniors. So the CMS proposal is significant in that it would extend coverage to patients between the ages of 55 and 74 with a 30-pack-year smoking history who currently smoke or have quit in the past 15 years. Under the CMS proposal, the first screening CT scan requires a “lung cancer screening counseling and shared decision-making visit” with a licensed health care provider.
Presuming the final rule closely reflects the proposed rule whenever it’s finally implemented, the ACA and the CMS decisions would create a strong foothold for lung cancer screening. The CMS proposal also requires participation in a data registry in an attempt to collect information to better refine future screening efforts.
The new coverage may, over time, go a long way toward eliminating the stigma surrounding lung cancer, which is evident in some of the public comments on the proposal posted on the CMS website. For example:
“This is an outrageous proposal! The message it sends to smokers is ‘don't worry—smoke your entire life then let the taxpayers fund your screening and care for your self-inflicted cancer.’ Medicare refuses to fund skin cancer screening yet is willing to pay for idiots who intentionally cause their poor health. What next—Medicare will pay for cigarettes if you only smoke one pack per day? Quit enabling smokers!”
And then there’s this:
“I urge you NOT to extend FREE coverage for CT lung scans to smokers. Smokers have been overconsumers of policyholders' and taxpayers' dollars for decades. I am a critical care nurse (for 40 years), advanced practice nurse, and supporter of most tenets of the ACA, but NOT this. Obviously, smokers can afford to pay for the CT scan; at least the cost of a carton of cigarettes. This is a waste of taxpayer dollars that can be channeled into other good health care causes.”
And, from the other side of this debate, this comment:
“I am so encouraged that this screening will allow lung cancer to be seen as a disease and not a stigma. To reduce the mortality of this disease is a humane and cost-saving decision.”
However it plays out, lung cancer screening will begin its next phase in 2015. Both the ACA and CMS screening policies are largely based on data from the National Lung Screening Trial (NLST), which showed an approximate 20% mortality benefit from lung cancer screening in certain patients at high risk for lung cancer. The United States Preventive Service Task Force’s 2012 B recommendation for CT lung screening is also largely based on NLST data.
The registry requirements should lead to better data that could help fine tune physicians’ understanding of which populations might best benefit (or not benefit) from screening. Such knowledge could better refine screening’s target population. Some screening advocates already believe the CMS cutoff age for screening, 74, is too early to stop the annual exams. Currently, there’s a paucity of data for older patients from the NLST because it included few patients over that age.
However it unfolds, 2015 represents a new stage in the evolution of screening for the cancer that kills more Americans than any other.
— Jim Knaub is editor of Radiology Today.
