David Gaffin and Cameron Ferrey, Technology Insights
Last month, the U.S. Preventive Services Task Force (USPSTF) finalized its lung cancer screening recommendations, calling for the use of annual low-dose computed tomography (LDCT) scans in eligible patients. The USPSTF released the new recommendations with a “B” grade, indicating their belief that “there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.”
The recommendations are, in effect, an endorsement of a controversial screening program that will affect many adults aged 55 to 80 who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years, and could have a considerable impact on cancer screening strategy more broadly.
How the industry is responding
Several health organizations publicly issued responses to the finalized recommendations. Proponents of the USPSTF recommendations attribute their support to the medical evidence in its findings. For example, the American College of Radiology issued a statement in support of the proposal, and announced plans to develop evidence-based infrastructure standards to facilitate expanded screening.
The Men’s Health Network also issued a press release stating that their organization “supports any policy or sound medically-based recommendation that makes it easier for men to access screening,” with regard to the report’s proposal.
New recommendations raise concern for some
However, there is some opposition. Opponents of the new recommendations are often concerned with cost, applicability across different care settings, and some misgivings regarding the clinical studies cited in the report. Notably, the American Academy of Family Physicians (AAFP) released an "I" recommendation earlier this month stating that there is insufficient evidence to recommend for or against LDCT screening for lung cancer, citing cost concerns.
These concerns are especially relevant, as CMS does not (currently) reimburse providers for the costs of lung cancer screening. However, they have historically taken USPSTF recommendations very seriously when determining clinical services coverage decisions.
The Advisory Board’s Oncology Roundtable recently published a blog post covering the reimbursement implications of the new USPSTF recommendations.
The AAFP further expressed “significant concern with basing such a far reaching and costly recommendation” upon the results of the National Lung Screening Trial (NLST), whose own authors seemed to call for caution in adapting their findings into practice, as “the cost-effectiveness of low-dose CT screening must also be considered in the context of competing interventions."
Many also question the relevancy of NLST results when applied to the community hospital setting, where strict follow-up protocols may not be followed as rigorously as in major medical centers and study participants.
Additional concerns center on the potential long-term harms from full-dose CT radiation exposure in follow-up scans, and skeptics also point out that among three European studies similar to the NLST, none observed the same degree of benefit from low-dose CT screening. This may indicate that further research is necessary to confirm the extent of benefits realized from expanded screening efforts.
The results of the NLST have been one driver of increased lung screening rates since 2010. The new USPSTF recommendations will undoubtedly contribute to this trend; our analysis predicts that demand for chest CT scans will increase by 20% from 2012 to 2022.
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