Is reimbursement for CT lung screening an inevitability?

On Wednesday, the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) will consider whether Medicare should cover low dose CT screening for lung cancer for high-risk individuals.

It has taken a while, but when results from the National Lung Screening Trial (NLST) showed that low dose CT for at risk individuals resulted in a 20 percent reduction in cancer mortality, it seemed inevitable we would get to this point, particularly after the U.S. Preventive Services Task Force gave low dose CT lung cancer screening its recommendation.

It's appropriate that one of the panelists at Wednesday's meeting will be Claudia Henschke, M.D. As leader of the Early Lung Cancer Action Project, Henschke oversaw a study that concluded that CT screening could detect stage 1 lung cancer when it is curable by surgery and could lead to a 10-year survival rate of between 80 percent and 90 percent among those diagnosed with the disease. The study created quite a bit of controversy, but was vindicated by the results that came out of the NLST in 2010.

A look at the 330 public comments submitted to the Centers for Medicare & Medicaid Services in advance of the MEDCAC meeting indicates that there is widespread support for low dose CT lung cancer screening, despite some concerns.

For example, Rebecca Smith-Bindman, M.D., professor of radiology and biomedical imaging at the University of California, San Francisco, urges that before CMS endorses and pays for CT screening, appropriate imaging techniques are used so that the benefits associated with screening (such as the aversion of lung cancer deaths) aren't compromised by deaths that might be caused by radiation associated with screening. Smith-Bindman, for years, has been outspoken when it comes to the issue of overradiation.

And, as demonstrated by a recent study carried out by Edward Patz, M.D., of the Duke University School of Medicine, and colleagues, there are risks associated with screening in the form of overdiagnosis. They argue that there is a need for better biomarkers and imaging techniques in order to determine which lung cancers are more or less aggressive so that screening programs can be optimized.

"It doesn't invalidate the initial study, which showed you can decrease lung cancer mortality by 20 percent," Norman Edelman, M.D., a senior medical adviser for the American Lung Association who was not part of the research team, told in HealthDay News following the study's publication. "It adds an interesting caution that clinicians ought to think about--that they will be taking some cancers out that wouldn't go on to kill that patient."

There will be a lot to talk about Wednesday at the MEDCAC meeting in Baltimore. FierceMedicalImaging will provide you with complete coverage. And if you want to follow the proceedings yourself, you can follow it here.

Until then, tell us: Do you think Medicare should cover CT screening for lung cancer? - Mike (@FierceHealthIT)

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