New Medicare Lung Cancer Screening Guidelines a Huge Step Forward – More Lives to be Saved
Providers Should Pursue Quality Assurance as Screening Proliferates
New Centers for Medicare and Medicaid Services (CMS) recommendations to lower lung cancer screening (LCS) initial age and smoking history requirements can make these exams the most effective cancer screening tests in history. The American College of Radiology® (ACR®), the GO2 Foundation for Lung Cancer and The Society of Thoracic Surgeons (STS) will work with CMS, medical providers and those seeking care to implement and update screening recommendations.
Lung cancer kills more people each year than breast, colorectal and prostate cancer combined. Annual lung cancer screening with low-dose computed tomography (LDCT) in high-risk patients significantly reduces lung cancer deaths.[1],[2]
Yet, less than 15% of Americans who met previous criteria are tested.[3],[4] The American Cancer Society predicts 131,180 lung cancer deaths in 2022. More-widespread screening could save 30,000–60,000 lives in the United States each year.
“I am enthusiastic about this Medicare expansion of eligibility for lung cancer screening,” said Douglas E. Wood, MD, a Past President of The Society of Thoracic Surgeons and Chair of the National Comprehensive Cancer Network Lung Cancer Screening Panel. “The U.S. has set records for falling rates of cancer mortality in the last few years, and this is largely driven by lower rates of lung cancer mortality since screening was approved by Medicare in 2015. Early detection of lung cancer allows more effective treatment and a chance to turn more cancer victims into cancer survivors.”
In addition to lowering the initial screening age from 55 to 50, and smoking history requirements from 30 pack years to 20 pack years, CMS expanded coverage to thousands of independent diagnostic testing facilities nationwide and retained a requirement that providers use Lung-RADS® structured reporting.
“Expanded lung cancer screening access can help doctors hit back against the nation’s leading cancer killer and ease lung cancer outcomes disparities — particularly among women, Black men and those in rural areas,” said Debra Dyer, MD, FACR, chair of the ACR Lung Cancer Screening Steering Committee. “Screening providers, particularly those starting new programs, should seek accreditation, use Lung-RADS®, take part in the Lung Cancer Screening Registry, and leverage educational offerings to maximize screening’s lifesaving benefit. Providers must act on this opportunity.”
To continue to broaden access to LCS for those who need it and optimize the lifesaving ability of these exams, CMS, payers and providers must continue to work together to:
- Simplify and streamline patient workflow.
- Reduce documentation burden on the provider.
- Reduce the administrative burden on providers and institutions.
To make LCS more accessible and save even more lives, CMS should consider the following steps moving forward:
- Continue Medicare coverage for older current and former smokers past age 78.
- Continue coverage for beneficiaries who stopped smoking more than 15 years prior.
- Inform future screening improvements by reinstating registry participation requirements.
- Drop the requirement for a shared decision-making session prior to the first screening (a current barrier to care).
“This is a major step forward in lung cancer screening coverage for the millions at risk for the disease,” said Laurie Fenton Ambrose, Co-Founder, President & CEO of GO2 Foundation for Lung Cancer. “We know we can save more lives and will continue to work with CMS to remove barriers and improve access to screening for the people this preventive service is intended to help, particularly the underserved. Our work to achieve equitable access of this lifesaving preventive service will not wane.”