The case for lung cancer screening with low-dose computed tomography (LDCT) among high-risk older adults is not settled, according to the author of a new commentary being published in Annals of Internal Medicine.
Recently, the United States Preventive Services Task Force recommended lung cancer screening with LDCT for high-risk older adults and private insurers are required by the Affordable Care Act to cover the procedure. As such, many were surprised when, after convening to review the evidence, the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) gave the procedure a vote of low confidence. MEDCAC cited insufficient evidence to show that the benefits of screening high-risk older adults for lung cancer outweigh the harms.
Renda Soylemez Weiner, MD, MPH, a pulmonologist at Boston University School of Medicine, explains the nuance of this conclusion. She cautions that the risks for complications from biopsies and post-operative mortality increase with age, as does the risk for false positive screening results. Risk for death from other causes and the development of co-morbidities also increase with age, diminishing the benefit of potential extended life from screening.
Dr. Weiner points to the overzealous implementation of prostate cancer screening as a cautionary tale for those demanding immediate widespread coverage of Medicare beneficiaries. She suggests that the Centers for Medicare and Medicaid Services (CMS) look to the Veterans Health Administration's (VHA) 8-site demonstration project as an example of LDCT screening done right because the program "includes a plan for careful data collection and evaluation to inform how benefits and harms of LDCT screening are balanced in the real world setting." Learning from these examples, CMS may want to consider covering LDCT only in facilities like the VHA where programs are certified as comprehensive, patient-centered, and are designed to maximize benefits and minimize harms.