Lung cancer screening beneficial for smokers and ex-smokers over 65

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94463987Lung cancer is the leading cancer killer in both American men and women, causing more deaths than colon, breast, and pancreatic cancers combined. According to the American Lung Association, almost 160,000 Americans are expected to die from lung cancer in 2014.

The US Preventive Services Task Force (USPSTF) recommends annual screening for lung cancer with low-dose computed tomography (CT) in adults ages 55 to 80 years old who have a 30 year history of smoking (a pack a day or more). However, Medicare is not required to pay for the scans, which cost between 200 and 400 dollars. The Medicare Evidence & Coverage Advisory Committee stated their reasoning for not recommending national Medicare coverage for annual CT screening is that the costs of lung cancer screening outweigh the benefits.

A recently published study in Annals of Internal Medicine might be enough evidence to change Medicare coverage requirements. Dr. Paul F. Pinsky of the National Cancer Institute and colleagues analyzed results from the NLST (National Lung Screening Trial) including almost 20,000 participants. The authors reported that NLST patients aged 65 years and older had a higher cancer prevalence and their scans had greater positive predictive value (PPV) than those of younger patients. The editorial accompanying the study stated that based on these results, Medicare beneficiaries should receive coverage for lung cancer screening.

In other cancer screening news, recent Lasker Foundation award winner (often referred to as the American Nobel Prize of medical science), Dr. Mary-Claire King, called for all American women 30 years or older to receive screening for cancer-causing genetic mutations in a recent JAMA article. Dr. King discovered BRCA1, the gene that when mutated increases the risk of breast cancer.

ACSH s Dr. Gil Ross had these comments: With the obvious benefits for early detection of lethal lung cancer from spiral CT screening benefits both in terms of reducing suffering and death, and for the health economists, in terms of dollars saved from lung cancer treatments down the road this should have been a no-brainer. Thankfully, the review and editorial in the Annals of Internal Medicine should be dispositive on this issue, and along with the USPSTF recommendation, seniors should get their Medicare coverage for this screening (and we here at ACSH are not usually big fans of cancer screening).

As for Dr. King s recommendation for BRCA screening for all 30+ women, I d need more data before climbing on that bandwagon. Given the high risk conferred by those mutations, however, it might turn out to be more beneficial than harmful, as opposed to most other screening methods.