A victory for CT lung cancer screening, but more work lies ahead

Many in the imaging community were thrilled with the decision by the Centers for Medicare & Medicaid Services (CMS) to extend coverage of annual low-dose CT screening to Medicare beneficiaries at high risk for lung cancer, but now the work of educating patients and primary care physicians begins.

The decision to include coverage in its recently revealed draft proposal was somewhat of a surprise from CMS, considering the MEDCAC advisory panel gave a vote of low confidence earlier this year. Panelists were not convinced that enough evidence existed to definitively prove that CT screening had more benefits than harms in an older population.

This hesitancy on the part of the advisory panel is reflected in the draft proposal from CMS. First of all, coverage is restricted to those aged 55 to 74, whereas the U.S. Preventative Services Task Force recommendations suggested screening until age 80. There are a number of stipulations tied in with coverage as well, including requirements that radiologists interpreting scans have significant experience in reading CTs for possible lung cancer and that screening must take place in accredited centers. Facilities must also submit data on findings and follow-up to approved registries, which should help fill in some of the evidence gaps that currently exist.

One of the more interesting requirements is that patients must undergo counseling and shared decision making with their physician. During this time, the benefits and harms of screening, tips for smoking cessation and other important topics will be discussed.

Even if radiologists aren’t the ones directly counseling patients, they can play a role in educating physicians on how to discuss screening with their patients. For years now, there’s been a call for radiologists to increase their visibility in the care continuum, and this is a golden opportunity. From the major imaging associations down to individual efforts, experts in the imaging community can help spread the facts about the positives and limitations of CT screening for lung cancer. It’s important that all providers truly understand the test’s potential, but without exaggerating the benefits or scaremongering with regard to possible harms.

CMS is collecting public comment on the proposal until Dec. 10, and then a final decision will likely come in February of next year. The work of screening beneficiaries and collecting data will begin then, but the work of educating the broader healthcare community and patients begins now.

-Evan Godt
Editor – Health Imaging