Pack-a-day smokers in Medicare now have access to low-dose CT scans for the early detection of lung cancer even as experts continue to debate whether the benefits are worth the cost and risk of false positives.
On Thursday the CMS issued a national coverage determination giving certain Medicare beneficiaries immediate coverage for the screening test.
Some critics say the benefits of aggressive screening have been exaggerated while others point to complexities in setting up an appropriate screening program. Advocates of its use, however, say the technology can help save thousands of lives and lead to better understanding of the disease.
The CMS concluded that the body of evidence is sufficient to support covering scans for certain beneficiaries. “We believe this final decision strikes an appropriate balance between providing access to this important preventive service and ensuring, to the best extent possible, that Medicare beneficiaries receive maximum benefit from a lung cancer screening program,” Dr. Patrick Conway, the agency's chief medical officer and deputy administrator, said in a news release.
Medicare will cover lung CT scans once a year for beneficiaries who meet three key criteria. They must be 55-77 years old. They must be current smokers or have quit within the last 15 years, with a smoking history of at least 30 “pack years” (meaning they averaged one pack a day for 30 years). And they must receive a written order from a physician or qualified practitioner.
In 2013, the U.S. Preventive Services Task Force recommended annual lung cancer screenings using low-dose CT in certain patients, which meant most health insurers were legally required to cover it on a first-dollar basis. A Medicare advisory panel, however, recommended against coverage.
Advocates for lung cancer patients and radiology group representatives commended the CMS decision in a joint statement. It's “the first major blow against lung cancer,” Dr. Ella Kazerooni, chair of the American College of Radiology's lung cancer screening registry, said in the statement.
The coverage is expected to cost Medicare $9.3 billion over the next five years including the cost of scans, biopsies and treatments.
Lung cancer is the leading cause of cancer death among both men and women in the U.S. The National Cancer Institute estimated there were more than 224,000 new cases and 159,000 deaths from lung cancer in 2014. Approximately 90% of lung cancer deaths among men and 80% of lung cancer deaths among women are due to smoking.
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