Medicare coverage of lung cancer screening explained

Lung cancer remains a “stubborn killer” with a low survival rate.

But there is new hope for the prospects of combatting the disease thanks to the results of a large, years-long study and the recent decision by Medicare to pay for lung cancer screening for those at high risk.

The study that preceded that decision “involving 53,454 current and former smokers believed to be healthy showed that annual screening by low-dose computed tomography, or LDCT, could prevent three lung cancer deaths for every 1,000 people screened,” The New York Times reported.

Earlier this month, “the Centers for Medicare and Medicaid Services finalized plans to cover the costs for LDCT,” Forbes reported. “The decision to cover the exams will hopefully save up to 20,000 patients per year, but only through effective smoking cessation efforts will the greater impact of such a decision be realized.”

We asked David Mason, MD, chief of thoracic surgery and lung transplantation at Baylor University Medical Center in Dallas, about the study and its implications.

Explain this Medicare decision and what it means. 

You can talk about screening studies and the value of screening studies, but if it costs people money, people aren’t going to get screened. That was a barrier to entry. That’s a big deal now that Medicare is going to pay.

Who is eligible for the screening?

You need to fit the criteria for this particular patient population and that patient population is considered a high risk to get lung cancer.

This particular study screened people who are in that higher risk population, 55 to 80, and who are heavy smokers and/or have been heavy smokers and quit smoking relatively recently. So, in that patient population there is clear evidence that there will be lives saved by performing this test.

What should people take away from this decision?

The main message that should get out there is that you should see your doctor. You should get screened if you’re in that high risk patient population.  By doing so, there is the potential to pick up a cancer in its earlier stages, when it’s in a curable condition.

Can you discuss the problem of false positives on the screening?

False positives means that you see something that looks like it might be a lung cancer, but it proves to not be. On CAT Scan of the chest in screening for lung cancer most of the time that false positive is a lung nodule, or spot in the lung. The vast majority of lung nodules are not cancer.

There’s really no risk of the scan itself. The radiation exposure is minimal. It’s only when you start to act on findings of the CAT Scan that any real risk to the patient starts to be gained.

How common are false positives?

Lung nodules are common, depending on where in the country you live. The majority will have a negative CT, but a significant proportion will have some finding that needs to be followed up on.

What should patients do if there is a possible finding of lung cancer in the scan?

It’s very important that once that CT Scan is interpreted as having a finding that is a concern, that you see the right people who know what to do in this circumstance. It’s very important that you be referred to a specialist

Outside of this high risk patient population and those who smoke, what could people look for as possible risk factors for lung cancer?

A strong family history of cancers of any type. This is not data driven, but there are clearly family cancer clusters that don’t necessarily have a gene mutation. So I would say if there seem to be clusters or a large number of cancers in your direct family, that should raise concern.