How Can We Fulfill Lung Cancer Screening’s Promise?

Ella Kazerooni

This post was contributed by Ella Kazerooni, MD, FACR, chair of the American College of Radiology Lung Cancer Screening Committee and ACR Thoracic Imaging Panel.

It’s been nearly two years since Medicare’s decision to cover low-dose computed tomography (LDCT) lung cancer screening for high risk patients. A recent Cancer study noted that most family doctors say they discuss CT lung cancer screening with patients.

Why wouldn’t they? Lung cancer kills more people each year than breast, colorectal and prostate cancer combined and LDCT is the first/only test to significantly reduce lung cancer deaths.

The problem is (1) either these discussions are not as frequent as reported or (2) these discussions may not include all the facts. Screening referrals remain somewhat rare. These issues must be addressed if LDCT is to fulfill its promise of saving more lives than any cancer screening test in history. And regulators must work with providers to make this happen.

A recent American Academy of Family Physicians guest editorial indicated that low dose lung cancer screening adoption “is likely driven by factors other than a lack of knowledge. These factors may include patients’ ineligibility for screening, lack of awareness or availability of local screening clinics, and little or no clinical decision support or systems-based guideline implementation assistance.”

Another factor is that the shared decision-making concept (and how to do that effectively) is still evolving. Physicians may be trying to figure out how they carry that process out in their operations and with their staff.

Now add to that – Medicare just slashed technical component reimbursement for performing these exams in hospital outpatient facilities by 42 percent in the recent HOPPS final rule. This may result in screening being confined to large teaching hospitals in urban centers, leaving older current and former smokers in outer suburbs and rural areas with less access to this care.

The solutions to these problems are three-fold (and require our help):

  • Stay engaged: ACR continues to work with patient groups to ensure continued fair Medicare and insurance coverage for LDCT LCS. Keep a lookout for ACR communication on the recent HOPPS Medicare LDCT reimbursement cuts and, if necessary, respond accordingly.
  • Stay active: November’s Lung Cancer Awareness Month  provides the opportunity to raise awareness of lung cancer screening among your referring providers and patients. Use the resources that the ACR provides to reach out to them this month and year round.

We are all in this together.

  • What steps are you taking to create a quality, sustainable, effective CT lung cancer screening process?
  • What steps have you taken to reach out to your referring providers (particularly family docs and internists) on the benefits of LCS for their patients?

Please share your thoughts in the comments section below and join the discussion on Engage (login required).

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