Medicare to Cover Lung Cancer Screening

The Centers for Medicare & Medicaid Services (CMS) announced that the agency plans to cover lung cancer screening for certain former and current smokers, a decision that could affect an estimated 4 million people.

The federal agency issued a draft guidance on Nov. 10 that outlined annual lung cancer screenings with low-dose computed tomography (LDCT), as well as counseling about the process, as a preventive service for individuals aged 55 to 74 years old with no signs of lung disease. Individuals must have a history of smoking at least 30-pack years (eg. one pack per day for 30 years) and be current or former smokers who have quit within the past 15 years.

“Tens of thousands of lives will be saved by providing America’s seniors with fair and equitable access to the same lifesaving lung cancer screening that is now being offered to those with private insurance,” said Fenton Ambrose, president and CEO of the Lung Cancer Alliance, in a statement issued by the organization. "Now, we will focus our attention on making sure those who would benefit most from this screening actually get screened.”

[“The Time Has Come For Lung Cancer Screening” by Laurie Fenton, CURE 2012]

The decision follows the recommendation by the U.S. Preventive Services Task Force this past December for high-risk individuals to receive lung cancer screening, which ultimately made it a requirement for private insurers to cover the service in 2015. In April, a Medicare advisory committee voted against recommending lung cancer screening with LDCT out of concern that risks, such as false positives, unnecessary needle biopsies and risky surgery, would outweigh potential benefits. In response, more than 175 members of Congress signed letters this past September urging CMS to cover LDCT.

Richard Wender, chief cancer control officer with the American Cancer Society, said the society, along with many other organization, has been working with Medicare on a plan to cover the practice.

“We had the very interesting possibility that if Medicare did not provide coverage, you’d be covered (under private insurance) until you hit Medicare—and as your risk gets higher as you get older, you’d no longer be covered,” he said. “We like the way it turned out.”

While Medicare plans to cover screening for high-risk individuals, it will only occur at accredited facilities. In addition, data from each lung cancer screening performed under Medicare will be collected for a national registry to produce additional research regarding the preventive practice.

“We’ve learned a lot since when mammography was first recommended,” Wender says. “This really reflects a modern-day screening decision that recognizes from the outset how important it is to do it right.”

In addition to the evidence gathered from multiple lung cancer screening studies, guidelines also have narrowed in on a high-risk group and highlighted the importance of screening at accredited facilities. Because the number of these facilities may be limited, one goal is to broaden accessibility, says Wender.

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