Panel backs lung-cancer screening for some smokers
For the first time, government advisers are recommending screening for lung cancer, saying certain current and former heavy smokers should get annual scans to cut their chances of dying of the disease.
The New York Times
WASHINGTON — The U.S. Preventive Services Task Force on Monday recommended that heavy smokers get an annual CT scan to check for lung cancer, a major change in policy that experts said had the potential to save 20,000 lives a year.
Until recently, the medical consensus has been that there is too little evidence to justify lung-cancer screening, largely because a chest X-ray — the usual screening technique — seldom catches the cancer early enough for lifesaving surgery.
But that changed in 2010, when a large-scale clinical trial involving 53,000 patients that was conducted by the National Cancer Institute found that a CT scan, which detects much smaller tumors, could reduce mortality by 16 percent among patients at the highest risk of lung cancer. The findings provide the basis for the federal panel’s recommendation Monday.
Lung cancer claims about 160,000 lives a year — more than a quarter of all cancer deaths and greater than the toll from colorectal, breast, pancreatic and prostate cancers combined. Nearly 90 percent of patients with lung cancer die from it, in part because it is discovered too late.
The recommendation, still in draft form, has the potential to change medical practice by making CT screening the standard of care for the highest-risk smokers.
And because insurers cover procedures strongly recommended by the preventive- services task force, eligible patients would no longer have to bear the cost themselves. The procedure’s average price is about $170, according to Advisory Board, a health-care research firm in Washington, which polled oncology professionals.
Medicare also would begin reimbursing for the scan. A Medicare spokesman said the agency would not immediately comment on how much the new screenings could cost.
The task force’s final recommendation will be issued three to six months after a public-comment period, which ends Aug. 26, a spokeswoman said.
The recommendation is aimed at a high-risk population of current and former smokers: about 10 million people ages 55 to 80 who have smoked at least a pack a day for 30 years, or the equivalent, even if they quit as long as 15 years ago, said Michael LeFevre, a professor of medicine at the University of Missouri and a member of the task force. The task force did not recommend screening for people who could not tolerate subsequent treatment, like surgery.
The low-dose CT scan that is being recommended, which uses coordinated X-rays to provide three-dimensional views, has the potential to change the course of the disease by detecting it early enough for treatment to be effective.
The scan can detect much smaller tumors than chest X-rays can, said Dr. Mary Reid, an associate professor of oncology at the Roswell Park Cancer Institute in Buffalo.
“Imagine looking at a plum versus the end of your pen,” she said, describing the difference in size. “This kind of screening really shifts things to an earlier stage.”
“We’ve been waiting for something like this for lung cancer,” she added. “We haven’t been able to change the course of this disease.”
But Dr. Kenneth Lin, a primary-care physician who is also an associate professor of family medicine at the Georgetown University School of Medicine, was more cautious. “I’ll bring it up with patients,” he said of screening, “but I won’t necessarily push it hard.”
Lin noted that the National Cancer Institute study found the benefits of screening to be overwhelmingly among the highest-risk participants.
For the lower-risk participants, he said, the harms of early screening could outweigh the benefits. CT scans can pick up abnormalities that look like cancer but will not ultimately harm the patient, leading to unnecessary surgery or invasive tests like biopsies. The task force mentioned the potential harm of overdiagnosis but said it did not outweigh the benefits of screening in the target population.