Three years ago, Gordon Green, then 55, rejected his primary-care doctor's suggestion that he get screened for lung cancer.
But Green's history of smoking a pack a day for 30 years and his doctor's insistence changed his mind. And when his low-dose CT scan (LDCT) identified an early stage tumor in his left lung, Green underwent surgery at Lahey Hospital & Medical Center, a teaching affiliate of the Tufts University School of Medicine, Burlington, Mass. He has been cancer-free since. “It wasn't so long ago that lung cancer was a death sentence,” he said.
Green's experience reinforces the medical community's growing belief that annual CT screens of current or former smokers at high risk for lung cancer will save lives through early detection. The CMS has proposed covering screening for millions of eligible Medicare beneficiaries, which is expected to create a lucrative market for hospitals and medical manufacturers. Some CT scanner manufacturers are already marketing consulting services and technology to hospitals to help them develop their lung-cancer screening service lines. “Almost every one of our customers is looking at this,” said Michael Cwalinski, a product manager for the CT business at medical-imaging system manufacturer Siemens Healthcare North America.
But experts say setting up screening programs is complex. Hospitals also must train primary-care doctors on how to identify which patients should be screened, establish navigators to track and work with patients, and purchase or develop radiology workflow systems.
Using LDCT to screen these patients is “one of the greatest advances that the field of thoracic oncology has seen in decades,” said Dr. Andrea McKee, chair of Lahey's radiation oncology department.
Most health insurers are legally required to cover the screenings on a first-dollar basis in the wake of the U.S. Preventive Services Task Force giving the exams a “B” recommendation in 2013. And last year, the CMS proposed covering screening of Medicare beneficiaries between ages 55 and 74 who smoked a pack a day for at least 30 years, excluding patients older than 75.
However, a study published last year in the Journal of Clinical Oncology found the task force's recommendations would hike Medicare spending by $9.3 billion over five years. That total included $5.6 billion for scans, $1.1 billion for biopsies and other tests, and $2.6 billion more for cancer treatments.
Hospitals that offer lung cancer screening charge from $99 to $450 for a chest CT exam. The CMS proposal, by limiting beneficiaries' out-of-pocket costs, likely will lead to millions more people undergoing exams. About 9 million people meet the task force's recommendation for lung cancer screening. Proponents say the reduced-mortality benefit is at least equal or greater to mammography screening for women.