JAMA Finding Lends Support to Using Chest CT for Lung Cancer Screening

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Hospital-based radiology departments that began offering discounted chest CTs to current and ex-smokers who could pay cash for the procedure may have been right. New research published in JAMA indicates that the standard insurance-covered annual chest x-rays do little if anything to actually reduce lung cancer death rates.

A separate NEJM published study indicated that chest CTs could lower the death rate as much as 20 percent. Acting on this finding, large and well-respected hospitals have jumped on offering discounted chest CTs as a for-cash alternative to the standard annual chest X-rays. These hospitals include: Abbott Northwestern Hospital in Minneapolis; Rhode Island Hospital in Providence; Swedish Medical Center in Denver; Pomona Valley Hospital Medical Center in California; University of California, San Francisco (UCSF); University of Pittsburgh Medical Center; and University Hospitals in Cleveland.

However, because the test is being offered before a national recommendation by either the American Cancer Society or the U.S. Preventive Services Task Force, there has been criticism that hospitals are offering the test to serve their own interests rather than that of the patient, who is at risk from false positives and radiation exposure.

While chest CT as a lung cancer screening procedure is not covered by Medicare, Medicaid or private insurance, any needed follow-up diagnostic testing and treatment is covered. With increased competition for cancer patients, there is a big advantage in being the hospital that first spots the cancer.

“You have to ask the question whose interests are being served here,” Dr. H. Gilbert Welch, a Dartmouth researcher who studies cancer screening, said of hospitals’ sales pitches in an interview with Kaiser Health News. “Screening tests are a great way to recruit new patients that produce revenues with follow up biopsies and procedures.” (Read the Kaiser Health News story.)

From a public policy perspective, any lung cancer screening may now be hard to justify. If annual chest x-rays do not reduce mortality it makes little sense to pay for the procedures. In addition, the results of the NEJM CT study indicated that over 300 heavy smokers must be scanned to save one life over a 5-year period. At a price of $1,000 per scan, that one life saved would cost $300,000 just in scans and potentially much more when the cost of additional testing for false positives is figured in.

From the individual perspective, the argument is of course quite different. If annual chest x-rays are ineffective at detecting cancer early enough to impact mortality, but CTs can make a 20 percent difference in mortality, taking hospitals up on discount scan offers makes perfect sense. According to CDC statistics, lung cancer is the leading cause of cancer-related deaths in the United States.

Learn more about the JAMA study here.