The U.S. Preventive Services Task Force, whose recommendations determine which preventive services must be provided to health plan participants at no cost, has recommended that lung cancer screening for certain individuals be added to the list. The screening is a low-dose computed tomography (LDCT scan) which will be offered to all current or former smokers between the ages of 55 and 70 who have smoked the equivalent of a pack of cigarettes a day for 30 years and have smoked within the last 15 years.
The Task Force determined that about 20% of lung-cancer deaths could be avoided through early detection by a LDCT scan and treatment. That means approximately 20,000 deaths per year could be prevented of the 160,000 lung cancer deaths that occur each year in the U.S.
Lung cancer is the leading cause of cancer deaths in the U.S. Approximately 84 percent of lung cancers in the U.S. are attributable to smoking. Thirty-seven percent of American adults are current or former smokers.
Nearly 90 percent of people who get lung cancer die from it, usually because it’s found too late for treatment to succeed. Once the cancer has spread to areas near the lungs, survival drops 25 percent. Survival drops to just 4 percent once the cancer metastasizes to other parts of the body.
Chest x-rays are currently the usual screening technique. But x-rays rarely catch the cancer early enough. The National Cancer Institute conducted a lung cancer screening trial in 2010 which showed that those who received LDCT scans had a 20 percent lower risk of dying from cancer than those who received a diagnostic chest x-ray.
The Task Force’s recommendation is not without controversy. False-positive LDCT results occur frequently; LDCT scans can pick up abnormalities that look like cancer but will not ultimately harm the patient, leading to unnecessary surgery or invasive tests like biopsies.
The task force decided to give LDCT scans a “B” rating, which under the terms of the Affordable Care Act will require health plans to eventually to cover the test without cost sharing from patients. The recommendation is still in draft form and the Task Force is soliciting comments. The Task Force’s final recommendation will be issued three to six months after the public comment period, which ends on August 26, 2013. If the recommendation is finalized by the end of 2013, coverage will go into effect in 2015.
Whether LDCT scans would help younger or lighter smokers isn’t known, so scans are not advised for them. They also aren’t advised for people who quit smoking at least 15 years ago, or people too sick or frail to undergo cancer treatment.