The Centers for Medicare & Medicaid Services (CMS) announced plans on Monday to cover lung cancer screening with low-dose computed tomography (LDCT), based primarily on the National Lung Screening Trial (NLST). This comes as good news to many lung cancer specialists who have been calling for Medicare to cover the screening test, though it sits in contrast to a Medicare panel that recommended against covering screening earlier this year.
The CMS proposal, which is now open to public comment, would cover individuals aged 55 to 74 years without symptoms of lung disease. To be eligible, individuals would need to have a smoking history of at least 30 pack-years, and must either be a current smoker or have quit smoking within the last 15 years. Those criteria match the NLST and previous recommendations, but CMS also included a requirement for a written order for an individual’s first LDCT screening obtained “during a lung cancer screening counseling and shared decision-making visit.” Subsequent screens also need a written order, though from “any appropriate visit.”
The NLST included more than 50,000 individuals, and found up to a 20% lower risk of dying from lung cancer with LDCT than with standard chest radiography. Results of the study were first published in 2011 in the New England Journal of Medicine. Since then, the United States Preventive Services Task Force (USPSTF) recommended that all individuals with heavy smoking histories between the ages of 55 and 80 years should be screened; the new CMS proposal drops the age range down to 74 years, particularly relevant to Medicare populations.
In a study presented at the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago in June, researchers found that LDCT screening (in patients 55 to 80 years of age) would identify almost 55,000 additional lung cancer cases over only 5 years. The program would also add more than $9 billion in expenditures to Medicare, however; this number is likely lower with the age limit of 74 years. The screening test itself costs between $100 and $400.
The Lung Cancer Alliance’s Laurie Fenton Ambrose, who has advocated for LDCT screening, released a statement on Monday praising the CMS proposal. “Tens of thousands of lives will be saved by providing America’s seniors with fair and equitable access to the same lifesaving lung cancer screening that is now being offered to those with private insurance,” she said. “By issuing this decision, CMS has avoided creating a perplexing two-tiered system of coverage where lung cancer screening is an essential benefit for some but not for those at even higher risk for lung cancer—our nation’s seniors.”