This fall, officials with the Centers for Medicare and Medicaid Services (CMS) are debating the pros and cons of using low-dose CT scans to screen high-risk patients for early stage lung cancer, and whether to approve coverage for the screenings.
The decision may not be an easy one. It comes at a time in American medicine when experts are debating which tests are necessary and which are not. Last year, the United States Preventive Services Task Force weighed in on the matter, recommending in favor of annual CT scans for smokers at high risk.
According to the task force, those at high risk are current smokers between 55 and 80 who have smoked an average of a pack of cigarettes (20) a day for 30 years or those who have quit in the past 15 years but are within that age range and smoked that much for that long.
If caught in the early stages, lung cancer is curable with surgery. It’s predicted that screening could save as many as 20,000 lives a year.
The latest round of data in this ongoing debate came from MD Anderson faculty members Robert Volk, Ph.D., Ernest Hawk, M.D., and Therese Bevers, M.D., in the Sept. 24 issue of the Journal of the American Medical Association. In the commentary, titled “Should CMS Cover Lung Cancer Screening for the Fully Informed Patient?,” they concluded that, while all medical testing involves a certain level of risk, the benefits of screening this segment of the population outweighed the negatives. The authors also stressed that CT screening should only take place after the patient is fully informed of the benefits and drawbacks.
Those same comments were echoed by Volk, Hawk and Bevers in a Sept. 25 op-ed in the Houston Chronicle. Here’s an excerpt:
“The previous lack of an effective lung cancer screening method meant that most patients could only be diagnosed once symptoms surfaced, typically when the disease was advanced and often incurable. According to recent federal lung cancer statistics, only 15 percent of cases are typically found before the disease has spread. Patients with localized lung cancer have a 54 percent chance of surviving five years or more. In comparison, patients with advanced, metastatic disease only have a 4 percent chance of survival. By allowing for earlier detection through CT screening, research suggests that overall mortality from lung cancer can be reduced by as much as 20 percent.
Therefore, CMS should consider approving Medicare coverage for low-dose CT scans, but only if certain conditions are in place. First, CT scans should only be given to those with a long history of smoking. Studies have focused on adults 55 to 74 who have smoked the equivalent of one pack of cigarettes a day for 30 years and continue to smoke or have quit within the past 15 years.
Physicians and patients also must fully discuss the risks and benefits of the screening method before moving forward with the test. Patients must be fully informed of all their options prior to making a decision about any procedure.”
The entire commentary can be found here. A decision by CMS is expected by the end of the year.