Now that Medicare coverage looks likely for CT lung cancer screenings, are providers prepared to scan 9 million Americans every year for free?

On Monday, the notoriously conservative U.S. Preventive Services Task Force recommended annual CT screenings for high-risk patients, and eventual Medicare funding seems all but assured.

In the face of striking clinical evidence showing that CT has the potential to save at least 20 percent of future deaths from lung cancer, doctors hope that lung screenings for smokers will one day be as common as mammography for women.
One question remains, however: What work is required to make such hope a reality?

The USPSTF estimates that its recommendation affects 9 million Americans who smoked the equivalent of a pack a day for 30 years — a daunting number of people to reach, let alone screen.

Dr. Ella Kazerooni, chair of the American College of Radiology Thoracic Imaging Panel, cautioned that lung cancer screening is not just a CT scan. "There's a lot involved in terms of educating the public on whether the screening is appropriate for them, and what to expect from a screening test," she told DOTmed News.

Under current diagnostic definitions, one out of every four people screened will get a positive result. But further testing will show that the majority of those positive screens aren't lung cancer.

Patients must be educated on how common a positive screening is, what happens when the test is positive, and when it's appropriate to get screened.

Standardized practices around reading and reporting tests are also essential to ensure that your screening experience is the same no matter where you go.

"You want to get the same benefit of that screening test whether you go in for a screening at a major center with lots of experience or a program that's just getting started," said Kazerooni.

Additionally, experts will have to determine how large the lung nodule should be to be considered a positive screen.

For example, big lung cancer screening programs such as NLST (National Lung Screening Trial) used 4-5 millimeters as the cutoff point, resulting in a high number of positive screens — one out of every four scans — along with the risk of overtreatment, unnecessary testing and anxiety for the patient being screened.

However, another study shows that raising the size threshold to 8-9 millimeters would reduce unnecessary scans and testing while still catching almost all lung cancers.

There's also discussion in the scientific community around other high risk patients who don't smoke — for example, people who are at risk due to occupational exposures or who have first-degree relatives with lung cancer.

"Other things can raise risk aside from smoking history and age," said Kazerooni. "How we identify those individuals is also something that's very important."

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