Lung cancer screening

The US Preventative Services Task Force strikes again.  On Monday, the non-government panel issued a draft recommendation that heavy smokers should undergo yearly chest CT scans in order to screen for lung cancer.

The draft recommendation is a huge change in policy for the panel, which previously recommended against routine CT scanning.  The previous recommendation was based on inadequate data to demonstrate a benefit for lung cancer screening given that the current screening method with chest Xray still fails to identify a large number of cancers that could be treated with surgery.

But CT scans have a higher sensitivity for identifying smaller lesions than chest Xray.  The price of the average CT scan has declined over time, and a large-scale clinical trial from the National Cancer Institute found that CT scans reduced lung cancer mortality by 16% for the highest risk patients.  The trial enrolled over 53,000 patients.

The potential benefit of the recommendation could be some 20,000 lives a year.  Lung cancer is currently the second most common cancer for both men and women, but is the leading cause of cancer deaths for both men and women at roughly 160,000 lives a year.  That’s more than colorectal, breast, pancreatic and prostate cancers combined. Nearly 90 percent of patients with lung cancer die from it, in part because it is discovered too late.

The USPSTF has given the draft recommendation a “B” grade, meaning that it is strongly recommended.  Any recommendations with an “A” or “B” grade must be covered under the Affordable Care Act with no out of pocket payment to the patient – meaning no copay.  Additionally, Medicare would have to start covering the scans.  And that could mean savings for these high risk patients.

 

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About justgngr

the ramblings of a medical professional by day, judgmental ginger by night
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5 Responses to Lung cancer screening

  1. sqhc says:

    Reblogged this on Students for Quality Health Care and commented:
    new draft recommendations for lung cancer screening from the US Preventative Services Task Force

  2. justajeepguy says:

    My mom just passed away from lung cancer. She only smoked for 5 years, 18-23, but was around a lot of smokers. She had no other health issues. A chest xray in Nov revealed nothing. It wasn’t until April when she lost her voice, due to the cancer paralyzing one of her vocal cords, that a ctscan and other tests diagnosed the cancer. The cure turned out to be worse then the cancer.

  3. Thomas Kim says:

    I have to say this recommendation caught me by surprise. To be honest, I hadn’t been following the literature on lung cancer screening because I thought we were quite far from a reliable scheme. But I guess the May 2013 NEJM NLST trial was thought to be powerful enough to change some minds.

    Anyway, I think its quite important to underline that the USPSTF, historically quite conservative about screening and often requiring a higher burden of proof of benefit from screening protocols, does not consider cost as part of their recommendations.

    We should also realize this is selective screening, not universal screening, and I don’t know how the payment considerations will go into that, since in order to be selected to get this screening, you have to be high risk based on age(>55 years old), smoking exposure history (>30 pack-years), and years since quitting (<15years), as well as have a robust life expectancy (<79 y/o, no serious comorbidities). These factors shouldn't be lost on doctors nor the general public.

    I'll have to go back and read the NLST trial a little closer now.

    • justgngr says:

      I too was caught off guard by this recommendation, although granted it’s a draft awaiting public comments.

      Your comments about cost are absolutely true, as the USPSTF doesn’t look at costs at all when considering whether or not recommend a preventative service. And yes – definitely not universal screening as it’s based on risk.

  4. The USPSTF is requesting comments about the proposal — at this time they are still taking comments. I have a problem with the recommendation — there is almost no consideration of the cost or unintended consequences of the guideline. Although they mention that CT scan radiation can rarely cause cancer, they otherwise seem to skip over other dangers for patients who have lung nodules (most of which are benign) — biopsies, surgery, and complications thereof.

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