An advisory committee within the Centers for Medicare and Medicaid Services on April 30 rejected a proposal to provide Medicare coverage of low-dose CT (LDCT) scan exams for beneficiaries at high risk for lung cancer.

The proposal targeted patients with histories of significant smoking, yet the Medicare Evidence Development and Coverage Advisory Committee concluded there is insufficient evidence regarding the effectiveness of these scans.

Known as MEDCAC, the nine-member committee heard from proponents of LDCT screening for heavy smokers including the Lung Cancer Alliance. Laurie Fenton Ambrose, president and CEO of the Lung Cancer Alliance, told the panel that LDCT screening has been more rigorously tested and reviewed than any other screening method over more than 30 years. 

The United States Preventive Services Task Force (USPSTF) in December 2013 recommended annual screening for lung cancer with LDCT in asymptomatic adults ages 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. The USPSTF recommendation is based largely on results of the National Lung Screening Trial, which found that CT lung cancer screening (3 annual LDCTs) in high risk individuals significantly reduces lung cancer deaths.

"We have the benefit of the USPSTF recommendation which conducted an independent two-year evidence review resulting in a B grade for a population 55 to 80 with a heavy smoking history," Fenton-Ambrose told MEDCAC. "The threshold of evidence has been met to support Medicare coverage for lung cancer screening within the USPSTF population."

MEDCAC committee members disagreed, noting that questions remain regarding the application of the available evidence to the Medicare population and the likelihood that community-based screening would replicate the positive results of the National Lung Screening Trial without the safeguards of a rigorous randomized controlled trial. MEDCAC members also raised concerns about the ability to accurately identify high risk individuals in practice, patient adherence to lung cancer screening programs, the definition of a positive finding, as well as the potential impact of incidental findings on scans that may lead to unnecessary invasive procedures and adverse events.

In a written statement, the American College of Radiology said it was "deeply disappointed" by the failure of MEDCAC to vote in support of national Medicare coverage of LDCT screening for patients at high risk for lung cancer.

"Based on available evidence, including National Lung Screening Trial results, new guidelines and standards, and developing screening infrastructure--some of which MEDCAC members may not have been allowed to consider--the College continues to recommend that the Centers for Medicare and Medicaid Services provide full Medicare coverage of these lifesaving exams," according to the statement. "Lack of national Medicare coverage for CT lung cancer screening places many Medicare beneficiaries at a potentially lethal disadvantage to those covered by private insurance regarding lung cancer survival."

 

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