Much has changed since 2011 when the The National Lung Screening Trial (NLST) showed that screening with low-dose helical computed tomography (CT) rather than with chest radiography reduced lung cancer deaths by catching cancers at earlier and more treatable stages. Today, multiple organizations that evaluate clinical practices and set recommendations and standards for care have endorsed the test, and it is covered by some private payors including WellPoint (the first to cover), Blue Cross Blue Shield affiliates and Anthem affiliates. In addition, the Department of Defense (DoD), Department of Veterans Affairs (VA) and the Department of Energy (DoE) are in the process of providing low-dose CT to all of their eligible beneficiaries.
However, the test is still not covered by many other private payors as well as Medicare and Medicaid, the largest health care coverage providers for the patients that primarily stand to benefit from the test. The test is generally only recommended for patients that meet the criteria of those in the NLST study, which means that they should be between the ages of 55 and 74, and have at least a 30 pack-years smoking history.
Because of this lack of coverage, the publication of a new analysis of the NLST in the May 23 issue of the New England Journal of Medicine was cheered by advocates for expanding access to the test, especially to the elderly and poor. (Low income patients may have higher rates of heavy smoking.)
The analysis confirmed the results of the initial study publication and concluded that “the NLST initial screening results are consistent with the existing literature on screening by means of low-dose CT and chest radiography, suggesting that a reduction in mortality from lung cancer is achievable at U.S. screening centers that have staff experienced in chest CT.”
The American College of Radiology (ACR) shared the news on its website the week the study came out, and today saw both the Medical Imaging & Technology Alliance (MITA) and the Lung Cancer Alliance (LCA) chime in with their endorsements.
“Our priority now is the responsible deployment of low-dose CT for those at risk,” said Laurie Fenton Ambrose, President & CEO of LCA in a statement.
The LCA advocates its National Framework of Lung Cancer Screening Excellence and Continuum of Care as a way to advise potential patients on their rights and where they can be screened in a way that follows best practices and uniform standards.