Medicare to Pay for Early Lung Cancer Screening for Qualified Individuals

the Cancer Therapy Advisor take:

The Centers for Medicare and Medicaid Services (CMS) have indicated that annual low-dose computed tomography (CT) lung cancer screen for high-risk individuals will be covered by Medicare.

In a statement issued on Monday, the CMS stated that individuals who fit the criteria of the National Lung Screening trial (ie, are between the ages of 55 and 74; are a current smoker or have quit within the last 15 years; and have a 30 pack-year history of smoking). There are, however, additional criteria which include a written order from a physician, physician assistant, clinical nurse specialist, or nurse practitioner that would be obtained during a "lung cancer screening counseling and shared decision-making visit."

The announcement seems to go against the recommendations that were issued by the CMS advisory panel, which raised concerns about the benefit of screening compared with the potential for harm due to known issues such as high false-positive rate of CT screening, inability to assure quality scans with low radiation dose, the lack of consistent interpretation and diagnostic workup in routine practice, and indication creep outside of the intended screening population.

According to the president and CEO of the Lung Cancer Alliance, Lori Fenton-Ambrose, “CMS got it right.” Lung cancer is among the deadliest forms of cancer in part because it does not begin to show symptoms until the disease has spread to an advanced stage. This fact makes the concept of early screening all the more appealing.

The decision will now be subject to a 30-day comment period, although Ambrose and colleagues that the main concept of the current draft will remain at the close of the comment period.