Evidence for CT Screening for Lung Cancer?
Special Communication Clinical Review & Education
Editor's Note
Lung Cancer Screening With Low-Dose Computed Tomography for Medicare Beneficiaries Robert Steinbrook, MD
Lung cancer, the vast majority of cases of which are caused by smoking, is the leading cause of cancer deaths in both men and women in the United States. In 2014, about 160 000 people are expected to die from lung cancer, accounting for about 27% of all cancer deaths.1 Although the prevention of deaths from lung cancer is a public health priority, the role of screening has been unclear. In 2011, the National Lung Screening Trial found that screening with low-dose computed tomography (CT) reduced mortality.2 In 2013, the US Preventive Services Task Force Related articles pages 2016 issued a B recommendation and 2019 for screening with low-dose CT for high-risk current and former smokers, concluding that the screening was likely to offer moderate to substantial net benefit.3 In February 2014, the Centers for Medicare & Medicaid Services (CMS) initiated a “national coverage analysis” for lung cancer screening with low-dose CT for Medicare beneficiaries. In April 2014, CMS convened a meeting of the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) to review the available evidence. The committee voted that it had low to intermediate confidence that “there is adequate evidence to determine if the benefits outweigh the harms”4 in the Medicare population. MEDCAC does not make coverage recommendations; it reviews the evidence and answers the voting questions posed by CMS. In this issue of JAMA Internal Medicine, we publish 2 Special Communications about lung cancer screening with lowConflict of Interest Disclosures: Dr Steinbrook was a member of MEDCAC from 2010 to 2012. Rita F. Redberg, MD, MSc, the editor of JAMA Internal Medicine, is the chair of MEDCAC; as chair, Dr Redberg does not vote on voting questions before the committee. No other disclosures are reported. 1. American Cancer Society. What are the key statistics about lung cancer? http://www.cancer.org /cancer/lungcancer-non-smallcell/detailedguide /non-small-cell-lung-cancer-key-statistics. Accessed August 31, 2014.
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dose CT. Wood argues for coverage of low-dose CT screening for Medicare beneficiaries because it “can lead to early diagnosis and cure for thousands of patients each year in the United States.”5 Woolf et al make the case against such coverage because “[i]t is unclear if routine screening would result in net good or net harm,” noting the potential for “false-positive results, patient anxiety, radiation exposure, numerous diagnostic workups, and the complications of these workups.”6 These articles should help inform readers about the quality of the available evidence and the issues that CMS should take into account before it issues a final decision, which is expected in 2015. The decision about low-dose CT is one of the most consequential and closely watched coverage determinations that CMS has had to make in many years. At issue is not only whether low-dose CT will be covered but, if it is covered, the specifics, such as the number and frequency of scans, the beneficiaries who would be eligible, and the procedures to assure that scans are of high quality and that false-positive results are minimized. As CMS deliberates, an intensive lobbying effort is under way to influence the decision, with support from industry and various professional and advocacy organizations. In June 2014, 45 US Senators and 134 House Representatives, from both political parties, separately wrote to CMS to advocate for low-dose CT scans. The CMS owes it to Medicare beneficiaries to reach a timely decision about the coverage of lung cancer screening with lowdose CT based on medical evidence, not lobbying or politics. I hope that it does.
2. Aberle DR, Adams AM, Berg CD, et al; National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5): 395-409. 3. Moyer VA; U.S. Preventive Services Task Force. Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160(5):330-338. 4. Medicare Evidence Development & Coverage Advisory Committee. Posted scoresheet from April 30, 2014 meeting. http://www.cms.gov
/Regulations-and-Guidance/Guidance/FACA /Downloads/id68b.pdf Accessed August 31, 2014. 5. Wood DE. The importance of lung cancer screening with low-dose computed tomography for Medicare beneficiaries [published online October 13, 2014]. JAMA Intern Med. doi:10.1001 /jamainternmed.2014.5623. 6. Woolf SH, Harris RP, Campos-Outcalt D. Low-dose computed tomography screening for lung cancer: how strong is the evidence? [published online October 13, 2014]. JAMA Intern Med. doi:10 .1001/jamainternmed.2014.5626.
JAMA Internal Medicine December 2014 Volume 174, Number 12
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://archinte.jamanetwork.com/ by a Indiana University School of Medicine User on 05/11/2015
2023
Special Communication Clinical Review & Education
Editor's Note
Lung Cancer Screening With Low-Dose Computed Tomography for Medicare Beneficiaries Robert Steinbrook, MD
Lung cancer, the vast majority of cases of which are caused by smoking, is the leading cause of cancer deaths in both men and women in the United States. In 2014, about 160 000 people are expected to die from lung cancer, accounting for about 27% of all cancer deaths.1 Although the prevention of deaths from lung cancer is a public health priority, the role of screening has been unclear. In 2011, the National Lung Screening Trial found that screening with low-dose computed tomography (CT) reduced mortality.2 In 2013, the US Preventive Services Task Force Related articles pages 2016 issued a B recommendation and 2019 for screening with low-dose CT for high-risk current and former smokers, concluding that the screening was likely to offer moderate to substantial net benefit.3 In February 2014, the Centers for Medicare & Medicaid Services (CMS) initiated a “national coverage analysis” for lung cancer screening with low-dose CT for Medicare beneficiaries. In April 2014, CMS convened a meeting of the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) to review the available evidence. The committee voted that it had low to intermediate confidence that “there is adequate evidence to determine if the benefits outweigh the harms”4 in the Medicare population. MEDCAC does not make coverage recommendations; it reviews the evidence and answers the voting questions posed by CMS. In this issue of JAMA Internal Medicine, we publish 2 Special Communications about lung cancer screening with lowConflict of Interest Disclosures: Dr Steinbrook was a member of MEDCAC from 2010 to 2012. Rita F. Redberg, MD, MSc, the editor of JAMA Internal Medicine, is the chair of MEDCAC; as chair, Dr Redberg does not vote on voting questions before the committee. No other disclosures are reported. 1. American Cancer Society. What are the key statistics about lung cancer? http://www.cancer.org /cancer/lungcancer-non-smallcell/detailedguide /non-small-cell-lung-cancer-key-statistics. Accessed August 31, 2014.
jamainternalmedicine.com
dose CT. Wood argues for coverage of low-dose CT screening for Medicare beneficiaries because it “can lead to early diagnosis and cure for thousands of patients each year in the United States.”5 Woolf et al make the case against such coverage because “[i]t is unclear if routine screening would result in net good or net harm,” noting the potential for “false-positive results, patient anxiety, radiation exposure, numerous diagnostic workups, and the complications of these workups.”6 These articles should help inform readers about the quality of the available evidence and the issues that CMS should take into account before it issues a final decision, which is expected in 2015. The decision about low-dose CT is one of the most consequential and closely watched coverage determinations that CMS has had to make in many years. At issue is not only whether low-dose CT will be covered but, if it is covered, the specifics, such as the number and frequency of scans, the beneficiaries who would be eligible, and the procedures to assure that scans are of high quality and that false-positive results are minimized. As CMS deliberates, an intensive lobbying effort is under way to influence the decision, with support from industry and various professional and advocacy organizations. In June 2014, 45 US Senators and 134 House Representatives, from both political parties, separately wrote to CMS to advocate for low-dose CT scans. The CMS owes it to Medicare beneficiaries to reach a timely decision about the coverage of lung cancer screening with lowdose CT based on medical evidence, not lobbying or politics. I hope that it does.
2. Aberle DR, Adams AM, Berg CD, et al; National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5): 395-409. 3. Moyer VA; U.S. Preventive Services Task Force. Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160(5):330-338. 4. Medicare Evidence Development & Coverage Advisory Committee. Posted scoresheet from April 30, 2014 meeting. http://www.cms.gov
/Regulations-and-Guidance/Guidance/FACA /Downloads/id68b.pdf Accessed August 31, 2014. 5. Wood DE. The importance of lung cancer screening with low-dose computed tomography for Medicare beneficiaries [published online October 13, 2014]. JAMA Intern Med. doi:10.1001 /jamainternmed.2014.5623. 6. Woolf SH, Harris RP, Campos-Outcalt D. Low-dose computed tomography screening for lung cancer: how strong is the evidence? [published online October 13, 2014]. JAMA Intern Med. doi:10 .1001/jamainternmed.2014.5626.
JAMA Internal Medicine December 2014 Volume 174, Number 12
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://archinte.jamanetwork.com/ by a Indiana University School of Medicine User on 05/11/2015
2023
