The Dutch-Belgian Randomized Lung Cancer Screening Trial, known as the NELSON trial (de Koning et. al), published Jan. 29 in the New England Journal of Medicine (NEJM), reconfirms that annual lung cancer screening with low-dose computed tomography (LDCT) in high-risk patients significantly reduces lung cancer deaths.
With lung cancer screening, lung cancer can be identified at an early, treatable and curable stage. Given that the American Cancer Society predicts 142,000 lung cancer deaths this year, these results support that widespread screening could save 30,000–60,000 lives in the United States each year.
To Save More Lives from Lung Cancer:
- Screening older current and former smokers each year should be done far more widely
- Medical providers must become familiar with lung cancer screening guidelines and prescribe these exams for appropriate high-risk patients
- Drastically low Medicare reimbursement must be increased to support widespread screening
Lung cancer kills more people each year than breast, colon and prostate cancers combined. If implemented nationwide, this cost-effective test would save more lives than any cancer screening test in history. Medicare must provide adequate reimbursement for these exams. Primary care providers and thoracic specialists should order the CTs for their high-risk patients,"
Debra Dyer, MD, FACR, chair of the American College of Radiology (ACR) Lung Cancer Screening 2.0 Committee
Physicians not adhering to guidelines
Unlike breast and colon cancer screening, a patient's primary care physician must approve the patient for a lung cancer screening exam during a shared-decision making visit. Education of primary care physicians about who should be screened and how to refer to screening services is essential to patients receiving this lifesaving test.
Tests are under-covered by Medicare
Shortly after the decision to cover these vital exams, the Centers for Medicare & Medicaid Services slashed Medicare reimbursement to as little as $60 per exam in the hospital outpatient setting -; less than half the Medicare provider reimbursement for a mammogram.
This has restricted the number of facilities able to provide these scans to those that able to perform them at a loss. This impacts screening program growth and negatively impacts patient access to this lifesaving test. Reimbursement for lung cancer screening needs to be increased and appropriately valued.
False positives overstated
Previous psychological studies show that patient concern over cancer screening false positives is short-term with no lasting effects.
However, updates to Lung-RADS® -; a quality assurance tool to standardize lung cancer screening CT reporting and management recommendations -; has reduced false positive rates by 75 percent compared to previous studies.
"Updates to Lung-RADS in the last year, based on review of lung cancer diagnosis rates in the ACR Lung Cancer Screening Registry, will further reduce the number of false positive screens," said Ella Kazerooni MD, MS, FACR, chair of the ACR Lung-RADS committee and Lung Cancer Screening Registry.
"The massive lifesaving benefit of these exams, and the threat to older current and former smokers from this disease, outweighs any potential harms to the defined screening population. We must do all we can to ensure patients are appropriately referred and have widespread access to lung cancer screening CT," said Dyer.