Are Medicare Rules a Culprit of Low Lung Cancer Screening Rates?

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Requirements for Medicare coverage of CT lung cancer screening might be a factor for low screening rates among high-risk smokers.
Requirements for Medicare coverage of CT lung cancer screening might be a factor for low screening rates among high-risk smokers.

Screening rates among current and former heavy smokers remain “low and unchanged” since the US Preventive Services Task Force (USPSTF)'s December 2013 recommendation that high-risk individuals between ages 55 and 80 years undergo annual lung cancer screening with low-dose computed tomography (LDCT), according to a recent analysis published in JAMA Oncology.1

Tobacco smoking is believed to cause approximately 8 in 10 lung cancer deaths — 126,400 of the 158,000 people who died of lung cancer in the United States last year.1,2 The National Lung Screening Trial associated LDCT screening with a 20% reduction in lung cancer deaths among asymptomatic, high-risk men and women, compared with chest X-ray-based screening.3

When Ahmedin Jemal, DVM, PhD, and Stacey Fedewa, MPH, PhD of the American Cancer Society in Atlanta, Georgia, compared data from the 2010 and 2015 National Health Interview Survey (NHIS), however, they found that the proportion of high-risk smokers reporting LDCT over the past 12 months was 3.3% in 2010 and 3.9% in 2015, an insignificant difference (P = .60).

“Of the 6.8 million smokers eligible for LDCT screening in 2015, only 262,700 received it,” they noted. Nor did screening rates improve for any of the sociodemographic groups included in subgroup analyses.

“This national survey confirms the findings of prior single center studies and smaller surveys that lung cancer screening remains under-used among eligible individuals,” said Renda Soylemez Wiener, MD, MPH, of the Pulmonary Center at the Boston University School of Medicine in Massachusetts.

A previous study by researchers at the City of Hope National Medical Center in Duarte, California, found that a third of patients diagnosed with non-small-cell lung cancer (NSCLC) would have been eligible for lung cancer screening under the USPSTF recommendations.4

So why have those at high risk for lung cancer not sought LDCT screening in higher numbers?

Medicare rules could be one culprit, several experts told Cancer Therapy Advisor.

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“Medicare requirements for coverage of lung cancer screening are complicated and, while well-intentioned, may actually serve as a barrier to getting the test done,” Dr Wiener explained. “For example, Medicare requires a thorough, shared decision-making discussion using a patient education tool (called a decision aid) and reporting of all completed screening CT scans to a national registry, but many doctors' offices and hospitals are not yet equipped to meet these requirements.”

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