Should lung cancer screening be covered for Medicare beneficiaries?

Smoking is the most important risk factor for developing lung cancer. The National Lung Screening Trial (NLST) reported a reduction in lung cancer mortality in high-risk participants aged 55 to 74 who were randomly assigned to screening with low-dose computed tomography (LDCT) versus chest radiography. The U.S. Preventive Services Task Force (USPSTF) subsequently recommended annual lung cancer screening with LDCT for persons aged 55 to 80 who had ever smoked.

Next to smoking, age is the most important risk factor for lung cancer. To inform its recommendation for the Medicare population, CMS researchers conducted a secondary analysis of the NLST data to compare screening outcomes among Medicare-eligible persons with those under the age of 65. They found that both cancer prevalence and positive predictive value of lung cancer screening with LDCT were higher in the 65+ cohort than in the under-65 cohort.

The older group also had a slightly higher rate of false-positive screening results. The author of an accompanying editorial concludes from the analysis that Medicare beneficiaries should not be excluded from screening. Clinicians should share with their patients the age-specific estimates of screening benefits and harms to help make an informed decision.