Medicare will cover CT-lung screening in high-risk individuals

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140002752Organizations including the United States Preventive Services Task Force recommend CT lung screening for high-risk individuals. This group includes about nine million Americans and is defined as adults ages 55 to 80 years old who have a 30 pack-year history of smoking (one pack-year equals smoking one pack per day for a year; in other words, multiply the number of packs per day by the years smoked). The Affordable Care Act requires private insurers to cover the screening for this high-risk group.

Now, the Centers for Medicare and Medicaid Services (CMS) announced that Medicare will be covering this screening as well for those ages 55 to 74, who have at least a 30 pack-year history of smoking and who are either current smokers or have quit in the last 15 years. This comes with a caveat beneficiaries undergoing this screening will need a written order that can only be obtained during a lung cancer screening counseling and shared decision-making visit from a physician, physician assistant, nurse practitioner or clinical nurse specialist. A 30-day comment period is now officially in place, after which a final determination will be made.

Although CMS s advisory panel does not support this screening, citing concerns including: a high-false positive rate; the possibility of those not defined as high-risk seeking this screening; low quality scans due to low radiation dose and inconsistencies in interpreting results the science clearly does.

According to Charles Powell, MD, of Mount Sinai in New York and chair of the American Thoracic Society's thoracic oncology assembly, "Low-dose CT has been shown to reduce mortality when used to screen individuals who are at high risk for developing lung cancer because of their age and smoking history. Thoughtful implementation of lung cancer screening with strict attention to monitoring of screening program adherence to standards for centers of excellence and with routine utilization of smoking cessation and multidisciplinary management will help to maximize the benefits and minimize the harms of screening.

ACSH s Dr. Gil Ross adds, Although we have discussed the risks of routine screenings for certain cancers annual mammograms for women starting at age 40, PSA testing we believe the evidence clearly shows that increased coverage and use of spiral, low-dose CT scans for high-risk patients will save many lives from the terrible toll of lung cancer as a result of cigarette smoking. We fully support CMS s decision to cover these screenings for their high-risk beneficiaries.