Screening for lung cancer would cost billions

Screening older adults for lung cancer – the USA's leading cancer killer – has the potential to save thousands of lives, but at a cost of billions of dollars to the Medicare program, a new study shows. The new analysis is being released as leaders of the Medicare program are considering whether to pay for the screenings.

Researchers found that screening eligible smokers and former smokers with low-dose CT scans would allow doctors to detect 54,900 to 141,900 additional lung cancers – mostly at earlier, more curable stages — within five years, depending on how many people get screened.

The price tag for Medicare patients would cost $9 billion to $27 billion over the same time, also depending on the number of people screened, according to a new study released in advance of the annual meeting of the American Society of Clinical Oncology. That would increase an individual's Medicare premiums by $3 to $9 a month.

Screening people for lung cancer could make a huge dent in deaths from the disease, says lead study author Joshua Roth, a postdoctoral research fellow at the Fred Hutchinson Cancer Research Center in Seattle.

In 2011, a large study found that using low-dose CT scans to screen adults at high risk for lung cancer reduced mortality by 20%, compared to performing chest X-rays. The trial targeted a specific group of people at highest risk for lung cancer: current and former smokers, ages 55 to 74, who had consumed the equivalent of a pack a day for 30 years.

In 2013, the U.S. Preventive Services Task Force, a federal advisory panel, recommended lung screenings with a favorable grade of B. The Affordable Care Act requires that private health plans cover screenings recommended with a grade of A or B, with the exception of some older plans not covered by the law.

The health law doesn't require Medicare to cover the screenings, however. An outside advisory committee last month gave the screenings a rating of 2.2 out of 5, and recommended against providing Medicare coverage, due to uncertainty that the benefits outweigh the risks in the real world, outside of a carefully controlled trial. Medicare has not yet announced its final decision.

Screening people for lung cancer carries real risks, including increased radiation exposure and collapsed lungs, according to the task force.

Some are also concerned that hospitals will offer the tests to lower-risk patients as a way to boost profits.

"The marketing potential of this is so enormous," says Peter Bach, director of Memorial Sloan Kettering's Center for Health Policy and Outcomes, who requested the Medicare advisory panel review. "It triggers so many lucrative (follow-up) tests. The medical centers see this as a huge cash cow."