Medicare should not cover lung-cancer screening for smokers, CMS panel concludes

A Centers for Medicare and Medicaid Services (CMS) advisory panel concluded that Medicare should not cover annual lung cancer screening tests for heavy smokers, a recommendation that has been criticized by advocates of the screening test.

The CMS Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) made its determination in late April based on the high false-positive rate for the low-dose computed tomography (CT) screening, and a general lack of evidence on whether the scans are effective.

The United States Preventive Services Task Force (USPSTF) recommended late last year annual screening for lung cancer in adults 55 to 80 years old who have a 30 packs per year smoking history and remain heavy smokers or have quit smoking in the last 15 years, according to the guidelines. That recommendation, according to CMS, was based largely on the results of the National Lung Screening Trial, which found reduced risk of mortality for at-risk patients who received CT scans.

But the nine-member MEDCAC panel gave the use of the screening a vote of low confidence because the panel determined there was not “adequate evidence” that the benefits of the screening outweighed the potential harms, and that “clinically significant evidence gaps remain regarding the use of low-dose CT for lug cancer screening in the Medicare population.”

The American College of Radiology (ACR) argued in a statement that Medicare should continue to cover the screening.

“The absence of Medicare coverage for CT lung cancer screening, as recommended by the USPSTF, penalizes many seniors and may result in lives lost,” said Bibb Allen, MD, FACR, chair of the ACR Board of Chancellors, in a written statement. “We now have a chance to strike back against the nation’s leading cancer killer, but only if people have access to these lifesaving exams. We strongly urge CMS to act on the evidence and the USPSTF recommendations and provide full national coverage of CT lung cancer screening for high-risk patients.”

MEDCAC plans to provide CMS with its formal recommendation in November.