Awaiting Finalization of Lung Cancer CT Screening Recommendation

This summer, the United States Preventive Services Task Force (USPSTF) issued a draft recommendation that heavy smokers at high risk for lung cancer receive a CT scan each year, to help detect lung cancer in early stages. The USPSTF collected public comments through the end of August 2013, and is expected to release its final recommendation in the coming months. Previous studies failed to show the evidence to justify the screening, because the use of chest X-rays (the usual diagnostic tool) at the time did not detect small cancerous tumors. A study in 2010, however,  showed that CT scans could detect much smaller tumors, which would catch the disease in early stages when hope for effective treatment is the greatest. It is this 2010 study that helped form the basis of the new draft recommendation.

The American Lung Association lauded the draft recommendation and stressed the need for quick action to finalize the recommendation. “It is critical that the USPSTF move quickly to finalize these recommendations so that individuals who meet the guidelines for annual lung cancer screenings can begin to receive this preventive treatment,” according to Harold Wimmer, National President and CEO for the American Lung Association. Those receiving annual low-dose CT screenings are  “high risk individuals,” meaning current and former smokers, ages 55-79 years, who have “significant cumulative tobacco smoke exposure” and have smoked within the last 15 years.

The Disease

Lung cancer is the leading cause of cancer deaths for both men and women, killing 160,000 individuals each year. Almost 90 percent of lung cancer patients die from the disease. Early detection is key. The most significant risk factor for lung cancer is smoking, as 85 percent of those diagnosed have smoked. Although the screening is beneficial, it should not give smokers a false sense of security; the main message is still not to smoke at all.  If finalized, the recommendation for CT scans for smokers would be a grade-level B recommendation.According to the Advisory Board Company, a healthcare research firm, the average cost for this type of CT scan is $170.

Grading of Preventive Services

Services that are graded A or B are recommended by the USPSTF. Grade A means there is high certainty that the net benefit of the service is substantial. Grade B means that, although “there is a high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial,” the confidence in the studies is constrained and it is possible that the this recommendation could be changed if more information is received. Under the Patient Protection and Affordable Care Act, health plans that are not grandfathered must cover all services with a grade of A or B and may not require cost sharing.