The Centers for Medicare & Medicaid Services (CMS) announced that the agency plans to cover lung cancer screening using low-dose computed tomography (LDCT) for certain former and current smokers, a decision that could affect an estimated 4 million people.
The federal agency issued a draft guidance on November 10 that outlined annual lung cancer screenings with LDCT and counseling about the process, as a preventive service for individuals aged 55 to 74 years old with no signs of lung disease. The guidance is meant for individuals with a history of smoking at least one pack per day for 30 years and former smokers who have quit within the past 15 years.
“Tens of thousands of lives will be saved by providing America’s seniors with fair and equitable access to the same lifesaving lung cancer screening that is now being offered to those with private insurance,” Fenton Ambrose, president and CEO of the Lung Cancer Alliance, said in a statement issued by the organization. "Now, we will focus our attention on making sure those who would benefit most from this screening actually get screened.”
The decision follows the recommendation by the United States Preventive Services Task Force this last December for high-risk individuals to receive lung cancer screening, which ultimately made it a requirement for private insurers to cover the service in 2015. In April, a Medicare advisory committee voted against recommending lung cancer screening with LDCT out of concern that risks, such as false positives, unnecessary needle biopsies, and risky surgery would outweigh potential benefits. In response, more than 175 members of Congress signed letters this past September urging CMS to cover LDCT.
Richard C. Wender, MD, chief cancer control officer with the American Cancer Society, said the society, along with many other organizations, has been working with Medicare on a plan to cover the practice.
“We had the very interesting possibility that if Medicare did not provide coverage, you’d be covered (under private insurance) until you hit Medicare—and as your risk gets higher as you get older, you’d no longer be covered,” he said. “We like the way it turned out.”
While Medicare plans to cover screening for high-risk individuals, it will only occur at accredited facilities. In addition, data from each lung cancer screening performed under Medicare will be collected for a national registry to produce additional research regarding the preventive practice.
“We’ve learned a lot since when mammography was first recommended,” Wender says. “This really reflects a modern-day screening decision that recognizes from the outset how important it is to do it right.”
In addition to the evidence gathered from multiple lung cancer screening studies, guidelines also have narrowed in on a high-risk group and highlighted the importance of screening at accredited facilities. Because the number of these facilities may be limited, one goal is to broaden accessibility, says Wender.
“First priority is to build capacity to make sure the centers can meet specific quality program requirements,” he says. “Right along the same time will be some broad public education about who should consider screening, which (may involve) a large learning curve…that this is really only for people who have a very high risk of lung cancer.”
James L. Mulshine, MD, vice president and associate provost for research at Rush University Medical Center in Chicago, worked on the International-Early Lung Cancer Action Project, one of the lung cancer screening trials that provided evidence of benefit. The CMS ruling presents an opportunity to not only cure lung cancer in high-risk individuals, he says, but also motivate current smokers to quit.
“We now have to work to make sure that broad access to high-quality screening service with informed decision making and access to smoking cessation occurs for those at highest risk for this cancer,” Mulshine says.
Providing coverage for screening, as well as the discussion around it and smoking cessation, will be key for patients, but also for primary-care physicians and internists, who will be recommending the screening for their patients.
“This was a critical step. We can’t do anything without coverage, but in some respects, we recognize that the hard work is just starting—to create national capacity to reach as many people as possible with high-quality screening,” Wender says.