American Lung Association Statement on the CMS Decision Coverage on Lung Cancer Screening
(February 27, 2015) -
On February 5, 2015, the Centers for Medicare and Medicaid Services (Medicare) announced the final coverage determination for receiving an annual low-dose computed tomography (LDCT) scan for lung cancer screening without cost sharing. The American Lung Association applauds Medicare for finalizing its coverage determination and looks forward to working to educate everyone at high risk for lung cancer. The Lung Association is confident that screening to find the disease in an early and curable stage will significantly improve survivability. Coverage is immediately available to all meeting the criteria shared below.
Lung cancer is the leading cause of cancer death for both men and women in the United States. Of all cancers, it has one of the lowest five-year survival rates at only 16.6 percent. Screening for individuals at high risk has the potential to dramatically improve lung cancer survival rates by finding the disease at an earlier, more treatable stage. The United States Preventive Services Task Force (USPSTF) estimates that if everyone who is at high risk were screened, there would be a 14 percent reduction in lung cancer deaths in the United States.
The American Lung Association is pleased that Medicare announced a final determination that:
- Approves coverage for LDCT scans in high-risk Medicare beneficiaries—those 55 to 77 years of age, who have a smoking history of smoking up to 30 pack-years (equivalent of one pack of cigarettes a day for 30 years), currently smoke or who have quit smoking within the last 15 years and have no signs or symptoms of lung cancer.
- Requires smoking cessation counseling or counseling about the importance of quitting and staying quit prior to obtaining approval for a LDCT scan, as quitting smoking remains the best prevention against the development of lung cancer.
- Radiologists conducting LDCTs must be certified by an appropriate professional society and have documented training and experience in interpreting lung cancer LDCT scans.
- A prospective registry to collect standardized data on the entire patient experience
- Requires initial shared decision making consultation but will not require further doctor visits beyond the first screen. Such additional visit requirements would potentially add costs, reduce compliance and unnecessarily burden Medicare, patients, providers and healthcare systems.
- Requires imaging facilities to make smoking cessation available to current smokers.
The Lung Association strongly believes that the proposed decision to provide LDCT screening to eligible Medicare beneficiaries is a crucial first step in reducing lung cancer deaths in those at the highest risk. As the screening process is further implemented in the real world setting, the Lung Association continues to urge Medicare to:
- Revise its eligibility criteria to be analogous with those of the USPSTF final recommendations to alleviate confusion among providers and their patients as well as to ensure those most at need for screening get the services.
- Implement the National Cancer Institute’s National Lung Screening Trial's (NLST) recommendation that once a patient has qualified into a screening program, they are not forced to exit when they reach the 15-year mark of cessation.
- Refine the asymptomatic criteria to ensure that patients with chronic cough are not inappropriately excluded for screening and that those suspected of lung cancer a priori are sent through a diagnostic process rather than through the screening process.
- Allow for evidence development for those at-risk groups, e.g., high-risk workers, not included in the NLST, but for which biological plausibility exists for an increased risk of lung cancer.
- Consider the use of risk prediction models that incorporate not only age and smoking history, but also health status and the potential risks of diagnostic work-up and treatment in future coverage determinations. The NLST criteria represent a starting point but they do not capture all high-risk groups nor consider risks.
A strategic imperative of the American Lung Association is to "defeat lung cancer" and the American Lung Association has great interest in reducing the morbidity and mortality associated with this lethal disease.
Provider and patient education is essential to successful LDCT lung screening. The American Lung Association is set to spearhead this endeavor and has created resources to educate and contribute to the success of widespread lung cancer screening.
The Lung Association has convened a Lung Cancer Subcommittee Screening Committee, chaired by Jonathan Samet, MD, MS, to review the current scientific evidence on lung cancer screening in order to assist the Lung Association in offering the best possible guidance to the public and to those at high risk for lung cancer.
To determine who is included in the high risk criteria, visit Lung.org/lcscreening, which also shares decision tools and checklists to guide the discussions between patients, physicians and insurance companies.