Low-Dose CT Screening for Lung Cancer Now Covered by Medicare

To boost early detection and save lives, Medicare now covers annual screenings for patients at greatest risk of developing lung cancer.

Under new guidelines released by the Centers for Medicare
& Medicaid Services (CMS), patients who meet specific risk criteria can now undergo annual low-dose CT screening for lung cancer. A counseling visit to discuss the patient’s risk of lung cancer as well as screening benefits and harms also is covered.

“This is a great decision by CMS,” says Peter Mazzone, MD, MPH, Director of the Lung Cancer Program in Cleveland Clinic’s Respiratory Institute. “Lung cancer is far and away the leading cause of cancer deaths. If caught early, upward of 60 to 90 percent of early-stage lung cancer tumors are curable.”

Stemming an epidemic

The incidence of lung cancer has doubled over the past 30 years, causing nearly 160,000 deaths each year ‒ more than breast, colorectal, prostate and pancreatic cancers combined.

CT scans are currently the only approved method for detecting asymptomatic lung cancer in its early stages, when the disease is most treatable. The doses of radiation used in the screening CT are five times lower than the doses used in regular CT scans.

The National Cancer Institute’s National Lung Screening Trial reported in 2011 that annual low-dose CT screenings reduced lung cancer deaths among high-risk patients by 20 percent, with acceptable risks, when performed in high-quality screening programs.

Medicare eligibility criteria

Under Medicare guidelines, patients are eligible for annual low-dose CT screening for lung cancer if they:

• Are 55 to 77 years old
• Are smokers, or past smokers who quit within the past 15 years
• Have a smoking history equivalent to a pack a day for 30 years
• Show no signs or symptoms of lung cancer
• Are healthy enough to tolerate treatment for early-stage lung cancer if needed

For patients with severe lung or heart disease or other complex conditions, the risks of lung cancer screening outweigh the benefits. Patients presenting with new or unexplained cough, shortness of breath or other symptoms suggestive of lung cancer should be referred for evaluation of their symptoms rather than for screening.

A written order for lung cancer screening is required. Dr. Mazzone hopes that ordering CT screening for lung cancer will soon become second nature in primary care practices, much like ordering breast, colon and prostate cancer screening is now.

Benefits outweigh risks today

“The research has come far enough to know that the benefits of lung cancer screening ‒when used properly ‒ outweigh the harms,” says Dr. Mazzone. The risks of screening include radiation exposure, false positive results and complications from follow-up diagnostic procedures.

Referral to a high-quality, multidisciplinary program minimizes the potential for unnecessary diagnostic procedures and overtreatment. “Outcomes improve when specialists with experience in evaluating and managing lung nodules and early lung cancers are involved,” says Dr. Mazzone.

Patients referred to Cleveland Clinic’s lung cancer screening program are counseled on risks and benefits by a pulmonologist or by a trained physician extender under the supervision of a pulmonologist. If patients meet the criteria for and consent to screening, low-dose chest CT is performed and interpreted by a chest radiologist.

Lung Nodule Clinic

Should a nodule or early-stage cancer be detected, patients are referred to the Lung Nodule Clinic, where pulmonologists, thoracic surgeons and other specialists discuss further treatment options. If resection is required, minimally invasive techniques are used to improve surgical outcomes and ease recovery.

All patients screened for lung cancer at Cleveland Clinic also are educated on the benefits of smoking cessation.

Every lung screening center submits data on each patient’s smoking history, CT dosage and screening results to a CMS-approved national registry. The registry ensures that centers produce high-quality outcomes and may further the research and development of new lung cancer screening and treatment tools.

Cancer Clinical Trials

Patients referred to Cleveland Clinic’s Taussig Cancer Institute ‒ a top-ranked cancer program, NCI-designated Comprehensive Cancer Center and part of the National Comprehensive Cancer Network ‒ have access to one of Ohio’s largest clinical trials programs.

The program offers access to national and local trials of novel and highly innovative treatments for early through advanced stages of disease. Many trials are accessible at community locations, including:

• Beachwood, Independence, Strongsville and Wooster family health centers
• Fairview Hospital in Cleveland
• Hillcrest Hospital in Mayfield Heights
• South Pointe Hospital in Warrensville Heights
• Cleveland Clinic Cancer Centers in Sandusky, Clyde and Mansfield

Even patients being treated at our main campus can participate in certain trials in the community.

“Second opinion evaluations at Cleveland Clinic always consider clinical trials as an option and recommend them when appropriate,” notes Cleveland Clinic oncologist Abdo Haddad, MD.

To search open trials by disease, hospital, phase or number, visit clevelandclinic.org/CancerClinicalTrials.

To refer patients to Cleveland Clinic for lung cancer screening, call 855.REFER.123.