Should Medicare cover lung cancer screening at select sites?

At the end of April, the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) declined to support Medicare coverage for low-dose CT (LDCT) lung cancer screening, with many of the panelists arguing that there are too many doubts that the benefits of LDCT screening would outweigh the harms in the Medicare population.

But in an opinion article published last week in the Annals of Internal Medicine, Renda Soylemez Wiener, M.D., of Boston University, wrote that despite the concerns expressed by MEDCAC, "there are reasons to believe that LDCT screening can be implemented safely and effectively" within the Medicare community. For example, as reported by the Army Times last fall, the Veteran's Health Administration's LDCT project includes plans for data collection and evaluation in order to further help in the investigation of how the benefits and harms of LDCT are balanced in a "real-world" setting.

To that end, Wiener suggested that Medicare cover screening at least at those sites.

According to Wiener, the Centers for Medicare & Medicaid Services (CMS) could follow MEDCAC's lead and elect not to cover LDCT screening, something she called a "worst-case scenario." Such a decision, she said, could increase income-and age-based disparities in lung cancer outcomes.

"[E]conomically disadvantaged seniors--the same individuals that already have a disproportionate risk for developing and dying of lung cancer due to higher tobacco use and delays in receipt of care--would be either deprived of the opportunity of early detection and treatment or forced to prioritize health care expenditures," she wrote.

Analysis published in February 2013 determined that LDCT could prevent 12,000 deaths annually. The analysis used information from the National Lung Screening Trial, as well as U.S. population size and other data. 

To learn more:
- see the article in the Annals of Internal Medicine
- here's the Army Times article