Screening healthy people for cancer seems like a no-brainer. But it’s not as simple as it seems. Controversy swirls around differing recommendations for mammography screening for breast cancer. Now add lung cancer to the list.
Earlier this month, a federal advisory committee recommended Medicare should not reimburse for lung cancer screening with CT scans. That comes despite a 2010 national research finding that low-dose CT scans of heavy smokers could detect tumors earlier than X-rays and reduce the risk of death from lung cancer by 20 percent.
After that, the U.S. Preventive Services Task Force, which advises the government on the worth of screening tests, gave its OK to lung cancer screening for longtime smokers, ages 55 to 79. That means coverage will be required in 2015 for those with private insurance through the Affordable Care Act.
But the Medicare advisory committee recommended against paying for the scans, citing potential problems of false positives and radiation exposure. A final decision is expected this fall, but Charlotte radiologists expressed disappointment with the recommendation. “We’re kind of upset about it, let me put it mildly,” said Dr. Michael Kelley of Charlotte Radiology.
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Kelley has both personal and professional reasons for those feelings. His father died of lung cancer. A chest X-ray detected a tumor, and one of his lungs was removed. But within a year, the cancer had spread to his brain. If it had been discovered sooner, Kelley said his father would have had a better chance of survival. “If we get this early, your chance of survival is quite good,” Kelley said.
With the 2010 findings in mind, Kelley and other radiologists hoped more people would get screened because insurance would begin paying for it. Dr. James O’Brien of Mecklenburg Radiology Associates worries there will be a “two-tier system” with some insurance already paying for screening, but Medicare not paying.
O’Brien leads the Charlotte section of an international lung cancer screening trial. Results published periodically show screening to be effective, he said. But he’s not optimistic Medicare will cover it. “I don’t know that anything could convince Medicare at this point to offer any more screening tests. Health care is taking up a lot of our gross national product, and Medicare’s been charged with cutting costs.”
Dr. Edward Patz, a Duke University radiology professor, said it’s important to take time to “mine the data” from the research, to consider all the risks and benefits and weigh the cost of mass screening versus the number of true cancers identified.
“There are lots of different factors that go into this. It is not a simple formula,” Patz said. “When you implement a system like this, you need to make sure you do it right. We need to think about fiscal responsibility.”