April 6th, 2015 by Charlie Blackburn | NAACCReview Home Leave a comment

For the first time, Medicare will cover the costs of lung cancer screening for some beneficiaries, the Centers for Medicare and Medicaid Services (CMS) announced on February 5. The coverage applies only to screening with low-dose computed tomography (LD-CT) in beneficiaries considered to be at increased risk based on their smoking history.

“This is an important new Medicare preventive benefit since lung cancer is the third most common [nonskin] cancer and the leading cause of cancer deaths in the United States,” said Patrick Conway, M.D., CMS chief medical officer and deputy administrator for innovation and quality.

The National Coverage Decision (NCD) on lung cancer screening was largely based on the results of the NCI-sponsored National Lung Screening Trial (NLST), which found that participants screened with LD-CT had an approximately 16 percent reduced risk of dying from lung cancer compared with those screened with a standard chest x-ray.

To be eligible for Medicare screening coverage, beneficiaries have to meet criteria similar to those that were required for participation in NLST. Beneficiaries must:

  • Be between the ages of 55 and 77;
  • Be either a current smoker or have quit smoking within the last 15 years; and
  • Have a tobacco smoking history of at least 30 pack years, which is an average of one pack a day for 30 years.

Read Full Article (Excerpt of Article from National Cancer Institute, NCI Staff)

Comments by:
Dee W. West, Ph.D, Director, Cancer Registry of Greater California (NAACCR Member, Past President)

For decades scientists have searched for a screening test to identify lung cancer at an early and, therefore, a more treatable stage. The earliest studies in the 1960’s and 70’s tested chest X-Rays and sputum cytology; these studies failed to conclusively demonstrate increased health outcomes. In the 1990’s low dose helical computed tomography (LD-CT) was introduced and early studies cautioned about its use for children and people with high risk of cancer. In the early 2000s, the United States Preventive Services Task Force (USPSTF) reviewed existing studies and determined that there was insufficient evidence to recommend for or against LD-CT – although cancer was detected somewhat earlier there was no decrease in deaths. In 2011, the results of a NCI sponsored National Lung Screening Trial (NLST) were released, which found that participants screened with LD-CT had a 16% reduced chance of dying than those screened by X-Ray. 53,454 people participated in the NLST, were randomized to LD-CT or X-Ray, and were screened once a year for an average of 6.5 years. However, there were more false positive tests and related invasive procedures in the LD-CT group. Based on these findings, and some more recent studies, the CMS determined that the benefits outweighed the risks and decided to add LD-CT as an additional preventive service, but with specific eligibility criteria – ages 55-77, no signs of cancer, tobacco history of at least 30 pack years, and current smoker or has quit within the last 15 years. These were the same criteria for inclusion in the NLST.

To be paid for these screening tests, CMS will require all radiologists or facilities to submit data to a CMS-approved registry for all LD-CT lung cancer screenings performed. The elements to be reported at this time are: facility, radiologist, patient, ordering practitioner, model of CT scanner, indication, system, smoking history, radiation dose, and date. The catchment area for registration is all 50 states, territories, and the District of Columbia. These registries are required to have a steering committee, management plan, operational plan, a defined catchment area, ability to submit data electronically, use CMS standard data dictionary, mechanism to have a list of all participating facilities, and a quality assurance plan.

These will not be cancer registries, but registries to compile data to document and evaluate LD-CT screening in this group of participants. But adding an outcome component by linking these registries to cancer registries would create important research opportunities. We have experience and technical resources to work with CMS. This idea is similar to the NCI Breast Cancer Surveillance Consortium (BCSC), founded in 1994, which included six organizations and two affiliates and a coordinating center. The (BCSC) is a resource for researchers to examine the delivery and quality of breast cancer screening in the United States, including related patient outcomes. The BCSC has included over 2.3 million women, has over 9.5 mammograms, and has published over 450 scientific papers.

So, this announcement not only confirms that a new important screening tool is available to older Americans but has the potential for research on delivery of care and outcomes for lung cancer patients. NAACCR or individual cancer registries should consider exploring the opportunities made possible by this announcement.

The opinions expressed in this article are those of the authors and may not represent the official positions of NAACCR.



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