New Recommendations for Screening

On March 9, 2021, the USPSTF (U.S. Preventive Services Task Force) published new Lung Cancer Screening Guidelines. The new guidelines recommend screening for patients who:

• Are 50 - 80 years old
• Have a 20-pack year smoking history AND are a current smoker/former smoker quit within the past 15 years

The guidelines state that screening should be discontinued once a patient has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. (U.S. Preventive Services Task Force, 2021)

Our Lung Cancer Screening Ambulatory Care Pathway has been updated to reflect these updated guidelines. All other steps of the process have been reviewed and maintained.

Why do we screen?

The American Lung Association Reports that (American Lung Association, 2021):

• Screening for individuals at high risk has the potential to dramatically improve lung cancer survival rates by finding the disease at an earlier stage when it is more likely to be curable.
• Early detection, by low-dose CT screening, can decrease lung cancer mortality by 14 - 20 percent among high-risk populations.
• About 8 million Americans qualify as high risk for lung cancer and are recommended to receive annual screening with low-dose CT scans.
• If half of these high-risk individuals were screened, over 12,000 lung cancer deaths could be prevented.

Lung Cancer: The Facts

According to the American Cancer Society, “Lung cancer is by far the leading cause of cancer death among both men and women, making up almost 25% of all cancer deaths. Each year, more people die of lung cancer than of colon, breast, and prostate cancers combined” (American Cancer Society, 2021).

The American Cancer Society estimates that in the United States there will be:

• About 235,760 new cases of lung cancer in 2021 (119,100 in men and 116,660 in women)
• About 131,880 deaths from lung cancer in 2021 (69,410 in men and 62,470 in women)

Medicare Coverage for Lung Cancer Screening

Because these updated guidelines are new, the Centers for Medicare & Medicaid Services (CMS) has not yet updated their coverage to include these expanded guidelines. Medicare will cover Lung Cancer Screening for patients who:

• Are 55-77 years old
• Have a 30-pack year smoking history AND are a current smoker/former smoker quit within the past 15 years
• Are symptomatic for lung cancer

If a patient meets these criteria, their CT Lung Screening is covered 100% (no deductible or coinsurance). The Centers for Medicare & Medicaid Services (CMS) are currently evaluating their coverage of Lung Cancer Screening based on the new USPSTF guidelines. They expect to have new coverage determinations in early 2022.

PLEASE NOTE: Radiology will not perform the CT Lung Screening for a patient until there is preauthorization in place, so that there are no unexpected charges to the patient. If coverage is denied for the exam, the High Risk Screening and Genetics Clinic will assist with appeals and investigation of grant coverage opportunities.

If a patient does not have insurance coverage for the exam, does not qualify for grant funding, and still wants lung cancer screening performed, here is some information for the out of pocket cost of screening:

Resources

AmbulatoryCare Pathway Lung Cancer Screening Toolkit

LungCancer Screening Ambulatory Care Pathway

Quality& Safety Dispatch: Medicare Coverage for Lung Cancer Screening

References

American Cancer Society. (2021, July 15). Key Statistics for Lung Cancer. Retrieved from Cancer.org: https://www.cancer.org/cancer/lung-cancer/about/key-statistics.html

American Lung Association. (2021, July 15). Lung Cancer Fact Sheet. Retrieved from Lung.org: https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/resource-library/lung-cancer-fact-sheet

U.S. Preventive Services Task Force. (2021, July 15). Lung Cancer: Screening. Retrieved from https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening