Medicare Panel Says No to CT-Based Lung Cancer Screen
(HealthDay News) — The Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) recently recommended against screening of high-risk, older adults for lung cancer using low-dose computed tomography (CT), according to a news release from the American Academy of Family Physicians (AAFP).
The news release states that the recommendation by MEDCAC parallels the AAFP's lung cancer screening recommendation, citing insufficient evidence to recommend for or against lung cancer screening based on age and smoking history. However, the MEDCAC recommendation counters the U.S. Preventive Services Task Force (USPSTF) decision to screen high-risk older adults (adults aged 55–80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years) with low-dose CT.
Outlining the AAFP's position, Doug Campos-Outcalt, MD, spoke at MEDCAC, raising concerns with the USPSTF recommendation, according to the news release. Firstly, he said the National Lung Screening Trial, which formed the basis of the USPSTF recommendation, had conditions that were not reproducible in community settings and he had some concern with the study's design of modeling predictions. Additionally, the 20% reduction in lung cancer mortality seen in the study was likely a best-case scenario, he said. Radiation from repeat screening was also a concern, with the possibility of 25 lifetime scans in the targeted, high-risk group. The Centers for Medicare & Medicaid Services will make a final coverage decision in the fall.
"With widespread community screening, there are likely to be more complications and deaths, raising more doubts about all-cause mortality," Campos-Outcalt told the AAFP News.