Dr. Barry Kramer once had doubts that using low-dose CT scans to detect early lung cancer is a good idea based on his research suggesting that a high rate of false-positive results could increase patient anxiety and harmful follow-up tests.
But in 2011, as an investigator on the National Lung Screening Trial, he found a 20% reduction in deaths among current and former heavy smokers over age 55 who were screened using CT scans versus those screened using chest X-rays. Since then, Kramer, now director of the National Cancer Institute's Division of Cancer Prevention, has been an advocate of CT screening for the estimated 9 million Americans between 55 and 80 who have a smoking history of 30 years averaging a pack a day.
“In my estimation, the benefits outweigh the harms,” he said.
That will be the central issue on April 30 when the CMS convenes a meeting of the Medicare Evidence Development and Coverage Advisory Committee to decide if Medicare will cover annual screenings for lung cancer with low-dose CT scans for current and past heavy smokers. The panel will make a recommendation by the end of the meeting. The CMS expects to release a proposed decision memo in November and a final national coverage determination by February 2015.
Last December, the U.S. Preventive Services Task Force recommended such annual screenings for current or past heavy smokers ages 55 to 80. Under the Patient Protection and Affordable Care Act, that recommendation means private insurers are required to cover the screening on a first-dollar basis for their non-Medicare members. The test costs $300 to $400.
Many experts support Medicare covering CT scans for smokers. “Lung cancer is the leading cause of cancer death among both men and women and without screening we can make no headway,” said Dr. Ella Kazerooni, chairwoman of the American College of Radiology's Lung Cancer Screening Committee.