Simmering for a long time has been the issue of whether Medicare will reimburse for expensive CT scans as a component of lung screening programs. It has now been (probably) decided that Medicare will pay for such annual screenings in older patients with long history of heavy smoking (see: Medicare Proposes Paying for Lung Cancer Screenings for Older Longtime Smokers). Below is an excerpt of the article:
Medicare will cover annual screenings for lung cancer for older Americans with long histories of heavy smoking, the federal government said...in a proposal that would cover an estimated four million people, many of whom are at greatest risk for the disease. Monday’s draft decision by the Centers for Medicare and Medicaid Services would extend coverage for CT scans to Medicare beneficiaries who smoked at least a pack a day for 30 years or the equivalent, even if they quit as long as 15 years ago. Scans would cost recipients nothing; the coverage would apply to beneficiaries through age 74. The proposal follows a more sweeping recommendation last year by an influential government health panel that such smokers ages 55 to 80 get annual screenings, a policy shift that experts said had the potential to save 20,000 lives a year. That recommendation focused on current and former smokers at highest risk, a population of about 10 million Americans....[The new CMS draft] proposal made it clear that high-risk Medicare recipients would be included....But such draft decisions are rarely reversed, and public health experts, who largely welcomed the ruling, said they did not expect the main elements to change much....Nearly 90 percent of patients with lung cancer die from it, in part because it is often discovered too late. CT scans can detect much smaller tumors than a chest X-ray, the traditional screening technique, which seldom catches the cancer early enough for surgery to be effective. In 2010, a large clinical trial found that CT scans could reduce mortality by 16 percent among patients at the highest risk of lung cancer....CT scans can pick up abnormalities that look like cancer but will not harm the patient, leading to unnecessary surgery or invasive tests like biopsies. One concern was that false positives could lead to unnecessary procedures and harm to patients.
There are a couple of interesting points here worthy of further discussion. The first is that the coverage only applies to beneficiaries through age 74. Increasingly, various health screening procedures are not recommended for the oldest patients. Part of the rationale here is that the life span of older patients is limited by the aging process itself and they may also recover less quickly from various diagnostic and interventional procedures. In this same vein, the article make indirect reference to the detection of so-called incidentalomas on lung CT scans. These are benign lung lesions, better off undetected. that I have blogged about before (see: How to Avoid the Risks of a CT Incidentaloma; More (and Interesting) Discussion about Incidentalomas; Presidential Commission Report on the Management of Incidentalomas). They are better undetected because sometimes the diagnostic procedures required to rule out cancer may harm the patient. Radiologists and clinicians understand the incidentaloma problem and are using protocols and procedures to reduce their negative impact (see: Pulmonary Nodule: The incidentaloma).