Guest: Medicare should cover low-dose CT screening for lung cancer
Medicare should cover low-does CT scans for lung cancer, according to guest columnists Renee Klein and Janet Freeman-Daily.
Special to The Times
LUNG-cancer screening with low-dose CT scans could save up to 18,000 lives annually among those at high risk for the disease. But in late April, a federal advisory panel, the Medicare Evidence Development & Coverage Advisory Committee, voted against recommending these scans, which use computerized tomography, for people on Medicare and Medicaid.
Given that 82 percent of lung-cancer patients are age 60 or older, that’s an outrage. Medicare pays for flu shots, which save far fewer lives than these scans can.
Lung cancer is so deadly because 85 percent of cases are diagnosed when the cancer has already spread. Low-dose CT scans can reduce mortality by detecting lung cancer in early stages, when the survival rate is 10 times better than late stages. However, without Medicare coverage for these scans, it’s likely only those who can afford private health-care policies or out-of-pocket payments will get screened.
The American Lung Association and the American Cancer Society recommend low-dose CT scans. Major medical centers like Seattle Cancer Care Alliance offer it now. All private health-insurance plans are required by the Affordable Care Act to cover it in 2015. So why did the Medicare Evidence Development & Coverage Advisory Committee vote against it?
Perhaps committee members thought the scans are not as effective as other cancer-screening methods paid by Medicare. But wait: 320 low-dose CT screenings can prevent one death from lung cancer. You would need 400 mammograms or 871 sigmoidoscopy colon screenings to prevent one cancer death. Medicare covers those procedures, even though lung cancer kills more men and women than breast, colon and pancreatic cancers combined.
Perhaps members of the panel were concerned about false positives causing unneeded treatments and patient anxiety. But wait: New lung-cancer screening guidelines result in only 10 percent false positives, and those can be clarified by a follow-up scan or biopsy.
As a lung-cancer patient who has had 30-plus scans and three biopsies, Janet would definitely rather have regular screening and occasional biopsy than what happened to her — she went to the doctor with a slight cough and discovered she had advanced lung cancer. The current life expectancy for late-stage lung cancer is less than one year.
Perhaps it was the cost of screening millions of seniors that concerned the Medicare committee. But wait: This expense is countered by reduced treatment costs as well as a decrease in lost productivity.
Covering mammograms increases Medicare monthly premiums by $2.50 with no follow-up. Low-dose CT scans are estimated to increase premiums by $3 including follow-up visits. Janet’s three years of advanced-stage lung cancer have generated bills approaching $1 million.
We suspect part of the panel vote was old-fashioned stigma. Panelist Steven Woolf suggested Medicare’s money would be better spent on “tobacco control interventions.” How will telling a patient not to smoke help detect cancer earlier? Based on the same logic, heart patients should not have stress tests, since smoking is also a major risk factor for heart disease.
Low-dose CT scans are currently recommended only for people at high risk for lung cancer. That doesn’t include never-smokers like Janet or people with a familial risk, but it’s a start. Anything that reduces deaths from this awful disease is a step forward — its 16 percent survival rate hasn’t changed much in 40 years.
Those over 65, at increased risk simply due to age, deserve to have lung cancer screening covered by Medicare. Allowing the less affluent to die when there is a proven lifesaving test is unethical.
If you agree with us, write your congressional representatives and President Obama. Tell them Medicare should cover lung-cancer screening with low-dose CT despite the panel vote. Medicare is expected to issue a proposed coverage decision by November. The life of someone you love could depend on it.
Renée Klein is president and chief executive of the American Lung Association of the Mountain Pacific based in Seattle. Janet Freeman-Daily is a writer and retired Boeing engineer in Federal Way. Her blog: grayconnections.wordpress.com