CONTROVERSIES IN LUNG CANCER SCREENING IN OLDER PATIENTS

Abstract

The National Lung Screening Trial found a 20% decrease in lung cancer-specific mortality using low-dose computed tomography to screen individuals with a 30 pack-year history of smoking, aged 55–75 years. Increasing age is an independent risk factor for lung cancer. Thus, elderly patients stand to benefit the most from low-dose computed tomography screening. Based upon the peak age of lung cancer diagnosis, currently 71 years, screening until at least the age of 79 years will continue to provide benefit to the healthy elderly who have largely outlived their birth cohort. Consideration for low-dose computed tomography in older elderly individuals should be based upon functional status and reserve on a case-by-case basis. These adaptations are contained within the 2012 American Association for Thoracic Surgery Lung Cancer Screening Guidelines. The United States Preventive Services Task Force (USPSTF) voted in favor of low-dose computed tomography (LDCT) screening between ages 54–80 for 30 pack year smokers, because of this final recommendation published in 2013, private insurance plans, including those created under the Affordable Care Act, must cover lung cancer screening by January 1st, 2015. This recommendation also encourages Medicaid plans to provide screening services with no cost sharing; however, Medicare is not required to follow this recommendation. Instead, Centers for Medicare & Medicaid Services (CMS) reanalyzed the service, its presumed benefit, and potential risk to make a National Coverage Determination. The Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) met in April 2014, and disagrees with the screening recommendation. They believe, despite overwhelming evidence from NLST, that there is not have enough confidence in the available data to safely recommend screening knowing that the main benefit may not outweighed the potential harm. Disclosure of interest: None declared