From the Guidelines
Medicare covers annual lung cancer screening with low-dose computed tomography (LDCT) for beneficiaries aged 50 to 80 years who have a 20 pack-year smoking history, with no limit on years since quitting, as recommended by the most recent guidelines 1. The screening requires a written order from a qualified healthcare provider following a lung cancer screening counseling and shared decision-making visit. To qualify, patients must have no signs or symptoms of lung cancer and be healthy enough to undergo potential treatment if cancer is detected. The key points to consider for lung cancer screening are:
- Age: 50 to 80 years
- Smoking history: 20 pack-year
- No limit on years since quitting
- Shared decision-making visit before screening
- Written order from a qualified healthcare provider
- No signs or symptoms of lung cancer
- Healthy enough to undergo potential treatment The screening aims to detect lung cancer at earlier, more treatable stages, significantly improving survival rates compared to diagnosis at advanced stages. Before scheduling screening, patients should discuss their individual risk factors, potential benefits, and limitations with their healthcare provider to determine if screening is appropriate for their specific situation, as supported by the National Comprehensive Cancer Network (NCCN) guidelines 1.
From the Research
Medicare Age Guidelines for Lung Cancer Screening
- The US Preventive Services Task Force (USPSTF) recommended low-dose computed tomographic (CT) screening for high-risk current and former smokers with a B recommendation in 2013 2.
- The recommended age group for screening is current and former smokers aged 55 to 74 years, with at least a 30-pack-year smoking history 3, 4.
- The National Lung Screening Trial (NLST) demonstrated the efficacy of low-dose CT screening in reducing lung cancer mortality by 20% in the 55 to 74 age group 3, 5.
- However, the generalizability of the NLST results to a national screening program for the Medicare age group is uncertain, as 73% of NLST participants were younger than 65 years 2.
- Current guidelines endorse low-dose computed tomography (LDCT) screening for smokers and former smokers aged 55 to 74, with at least a 30-pack-year smoking history 4.
- The Centers for Medicare & Medicaid Services (CMS) should consider the potential harms and benefits of routine screening, including false-positive results, anxiety, radiation exposure, diagnostic workups, and resulting complications, before making a decision on coverage for Medicare beneficiaries 2.