One of the sad facts in health care in the United States is that millions of Americans who smoke or previously smoked heavily would benefit from lung cancer screening, but most of these individuals fail to be screened. Lung cancer ranks as the leading cause of cancer-related deaths, due in large part because most diagnoses occur when the patient is in a late stage of the disease. Lung cancer screening using low-dose computed tomography scans (LDCT) is effective in detecting early-stage lung cancer, but fewer than 5% of eligible individuals currently utilize lung cancer screenings.
With the right therapy, five year survival in lung cancer patients can exceed 80% for stage one lung cancer, compared with less than 10% for those patients treated when their cancer is in stage four. In issuing new lung cancer screening guidelines this week, the American Cancer Society is hoping to reverse this curve.
Earlier this year, the Centers for Medicare and Medicaid Services (CMS) announced finalized and significant modifications to its National Coverage Determination (NCD): Screening for Lung Cancer with Low Dose Computed Tomography (LDCT). In that action, CMS determined that the evidence was sufficient to cover - under Medicare Part B - a lung cancer screening counseling and shared decision-making visit for appropriate beneficiaries, and an annual screening for lung cancer with LDCT for those individuals who are age 50 – 77 years; asymptomatic (no signs or symptoms of lung cancer); have a tobacco smoking history of at least 20 pack-years (one pack-year = smoking one pack per day for one year; 1 pack =20 cigarettes); are a current smoker or one who has quit smoking within the last 15 years; and received an order from their physician for the lung cancer screening with LDCT.
ASC's new guidelines follow suit. The ASC recommends yearly screening for lung cancer with a low-dose CT scan for people aged 50 to 80 years who smoke or used to smoke and have at least a 20 pack-year history of smoking.
ASC recommends that before deciding to be screened, smokers and former smokers should have a discussion with a health care professional about the purpose of screening and how it is done, as well as the benefits, limits, and possible harms of screening. And the society urges that those who still smoke should be counseled about quitting and offered interventions and resources to help them.
With this year's new Medicare coverage decision and with the publication of ACS's new lung cancer screening guidelines, one hopes that physicians will urge millions of their patients who would benefit from early detection of lung cancer to be motivated to be screened using low-dose CT. So many could live longer, more productive and healthier lives if only they choose to do so.