The Reading Room

Why Medicare patients have the most to gain from lung cancer screening

by Solomon Banjo

In April, the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) recommended against Medicare coverage for low-dose CT (LDCT) lung cancer screening. Despite the demonstrated benefits of LDCT lung cancer screening in the National Lung Screening Trial (NLST), MEDCAC panelists were unconvinced that those benefits would be replicable within the Medicare population.

Researchers from the National Institutes of Health (NIH) took a second look at the NLST data to address this specific concern and published their findings last week. The data showed that lung cancer screening is more effective in the Medicare population, but that these patients are at higher risk of major complications.

MEDCAC concerns spur new analysis of NLST data

The researchers from the National Institutes of Health (NIH) reviewed the NLST data by dividing the NLST population into current and former heavy smokers eligible for Medicare and participants aged 55 to 64. The two groups were balanced for smoking history, adherence to screening protocols, and demographics. 

The Medicare-eligible group consisted of 7,110 patients and the under-65 cohort had 19,612 patients. The older cohort had a higher incidence of chronic comorbidities (e.g. COPD 17.1% v. 11.8%), were less likely to be current smokers (50.1% v 51%) and had a higher median pack-year smoking history (52 years v. 46 years). 

Lung screening benefits greater for Medicare population, but so are the risks

The table below highlights some of the major findings from the new analysis of the NLST data. The most compelling statistic from this new analysis is that it requires 119 fewer screening patients to prevent a lung cancer death in the Medicare population than in the comparison cohort (245 v. 364).  

Age is a major risk factor for many types of cancer, so it is unsurprising that older patients with greater smoking pack-years are more likely to benefit from lung cancer screening than their younger counterparts. 

Comparative Effectiveness of Lung Cancer Screening in Medicare & Non-Medicare Populations

Comparative Effectiveness of Lung Cancer Screening in Medicare & Non-Medicare Populations

The benefits of screening and early detection  for the Medicare population is tempered by a few data points that highlight the need for shared decision making and principled follow-up care for all screening patients, but especially  for older patients. 

Although the rate of major complications was low for both groups, the Medicare-aged cohort was almost twice as likely to suffer a major complication (3.4% v. 1.9%) as the comparison group. The older cohort also had a higher false-positive rate and greater number of invasive procedures. 

Implications for Medicare coverage

The schedule for Medicare’s decision on whether or not to cover lung cancer screening has not changed. We still anticipate the release of a proposed rule in November, with a final decision coming in February of next year. These new findings, coupled with congressional pressure, should give advocates of CT lung cancer reason to hope for a favorable decision in the coming months.

Learn more at the national meeting

Since the release of the original NLST study in 2011, the number of lung cancer screening programs has increased by over 300%. Register for our national meeting and access practices and tools necessary to establish and run a best-in-class imaging screening program.

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