Experts weigh risks, benefits of lung cancer screening for seniors

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Lung Cancer

Should Medicare cover the full cost of low-dose computer tomography screenings?
Should Medicare cover the full cost of low-dose computer tomography screenings?

HealthDay News -- The benefits and harms of low-dose computer tomography (CT) screening for lung cancer needs to be addressed in relation to the Centers for Medicaid & Medical Services (CMS) evaluation of screening coverage, according to two articles published in JAMA Internal Medicine.

Currently, the United States Preventive Services Task Force (USPSTF) recommends that high-risk current and former smokers be screened using low-dose CT; this recommendation requires private insurers fully cover the costs associated with low-dose CT scans. USPSTF is looking into extending full coverage of CT scans to Medicare beneficiaries.

Despite demonstrated efficacy of the low-dose CT in the National Lung Screening Trial (NLST) , some experts argue that implementing a nation-wide screening program may be premature.

"The magnitude of benefit from routine screening is uncertain; estimates are based on data from a single study and simulation models commissioned by the USPSTF," reasoned James H. Woolf, MD, MPH, of Virginia Commonwealth University in Richmond, Virginia, and colleagues.

Woolf explains that results of the NLST trial may not be accurate when screening patients aged 65 years and older, because 73% of the NLST participants were aged less than 65 years.

"Until better data are available for older adults who are screened in ordinary (nontrial) community settings, CMS should postpone coverage of low-dose CT screening for Medicare beneficiaries," wrote the investigators.

Reversely, Douglas E. Wood, MD, FRCSEd, of the University of Washington in Seattle, argues that expanding Medicaid coverage of low-dose CT would provide more benefit to patients aged 65 years and older, stating “…CMS should cover low-dose CT, thus avoiding the situation of at-risk patients being screened up to age 64 through private insurers and then abruptly ceasing screening at exactly the ages when their risk for developing lung cancer is increasing."

The harms associated with low-dose CT, such as false-positives, overdisagnosis, surgery-related concerns, and costs of follow-up can be "mitigated by clear criteria for screening high-risk patients, disciplined management of abnormalities based on algorithms, and high-quality multidisciplinary care,” wrote Wood.

References

  1. Woolf SH et al. JAMA Intern Med. 2014; doi: 10.1001/jamainternmed.2014.5626
  2. Wood DE et al. JAMA Intern Med. 2014; doi: 10.1001/jamainternmed.2014.5623
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