Should CMS cover lung cancer screening for the fully informed patient?

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Lung cancer is the leading cause of cancer death1 and an estimated 12,000 lung cancer deaths could potentially be averted each year in the United States through early detection with low-dose computed tomography (LDCT).2 The Centers for Medicare & Medicaid Services is currently considering national coverage of lung cancer screening with LDCT for individuals at high risk of developing lung cancer based on their age and smoking history.3 The U.S. Preventive Services Task Force (USPSTF) recently updated its recommendation about screening for lung cancer to recommend annual screening with LDCT for adults aged 55–80 years who have a 30-pack-year smoking history and who currently smoke or have quit within the past 15 years (B recommendation, update published December 31, 2013).4 In making its recommendation, the USPSTF weighed many factors including the estimated 16% mortality reduction associated with screening and surgical resection5 and the high false positive rate associated with screening.6 Unlike new private insurance plans, coverage of preventive services with a grade of A or B by the USPSTF is not mandatory for Medicare. CMS is allowed to cover additional preventive services if it determines through the Medicare national coverage determinations process that the service is reasonable and necessary for prevention or early detection of illness, is recommended with an A or B grade by the USPSTF, and it meets certain other requirements.