In an era where health screening resources are being scaled back as a cost-cutting measure, the new addition of Low Dose CT (LDCT) as a covered activity through Medicare allows more patients that are at risk for lung cancer to participate in annual screenings. High numbers of lung cancer deaths are attributed in part to the fact that lung cancer is often not detected until the late stages. Early detection, when combined with prompt multi-specialty treatment, can increase lung cancer survival rates significantly over late-stage detection.
Lung cancer causes more deaths than colorectal, breast, and prostate cancers combined. Nearly 160,000 Americans are expected to die from lung cancer in 2015, accounting for about 27 percent of all cancer deaths. Lung cancer is the third most common cancer and the leading cause of cancer death in the United States making the opportunity to identify and treat lung cancer earlier a significant development for our communities. (http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/lung-cancer-screening#Pod5)
No Co-Pay and Affordability
Many people fail to follow through with recommended lung screenings because they have not been covered previously by insurance. Because of the significant life-saving value identified by the U.S. Preventive Service Task Force, both commercial insurers and Medicare began covering LDCT in February 2015. When patients fit the criteria they can have annual LDCT with no out-of-pocket expense. Patients who have private insurance receive our assistance in either pre-qualifying with their insurance or using our affordable payment options. For heavy smokers, who comprise 85% of all lung cancer patients, annual screening is an important step for continued health.
Helping lead this effort in the region is Dr. Stacy Moulton who completed his residency and fellowship at the Mayo Clinic. He states that “the success of this approach has been demonstrated in highly credible studies. Greater participation in LDCT screening presents a huge health benefit for people in our communities. Doctors and health care professionals need to educate the public about the availability of no-cost LDCT screening for those who qualify.”
High-Risk and Coverage Eligibility
Heavy smoking is the greatest risk factor for lung cancer. Medicare coverage for screening covers those with a 30 pack year smoking history [anchor link} that are currently smoking or who quit less than 15 years prior and who are between the ages of 55 and 77. Studies have shown that this high-risk population receives the greatest benefit from annual screenings.
Heavy smoking means a smoking history of 30 pack years or more. A pack year is smoking an average of one pack of cigarettes per day for one year. For example, a person would have a 30 pack-year history by smoking one pack a day over 30 years or two packs a day over 15 years. A pack-year is defined as 20 cigarettes a day for one year. Someone who has smoked 40 cigarettes daily for 20 years has a 40 pack-year history. http://www.cancer.gov/types/lung/hp/lung-screening-pdq
High Sensitivity Low Dose Scanning and False Positives with LDCT
The LDCT has been shown to produce a high level of detail in detecting lung cancer. About 1-in-4 will have a positive finding, but more than 90% of that group will be identified as benign in a follow-up. Patients should view the screening as a part of an annual process, which may include a follow-up to rule out false positives. Referring doctors provide a “shared decision making” appointment prior to referring patients for screening to explain the process and the potential for false positives and high percentage follow-up findings that are benign.
LDCT is a specialized type of CT that allows for highly detailed lung scans with a radiation dose that is equivalent to 2 mammograms or 6 months of background radiation. The benefit for the high-risk group far outweighs radiation dose exposure at these minimal levels. LDCT uses low doses of radiation because the lungs are comprised primarily of air, and do not require high levels of radiation to provide accurate images of lung tissue.
Local Integrative Treatment Team
Radiology Associates of Fredericksburg (RAF) has facilitated the development of a local multi-disciplinary team of doctors ready to respond to cancer findings resulting from LDCT. The presence of a team prepared to work cooperatively and promptly with lung cancer findings is a best practice that should accompany lung cancer screenings to maximize the benefits of early detection. The availability of this team in our region completes the value of the early screening by providing for an appropriate response if a positive finding occurs. Adding RAF fellowship-trained radiologists to other specialties allows for a high-quality treatment regime to begin without losing additional time.
How Doctors Should Respond
The priority now is education. Reaching out to those who fit the heavy smoker and age profile to share about the opportunity for no-cost screening, pre-qualification assistance, or affordable payments for private pay. The RAF concierge can provide additional guidance to doctors regarding referrals and information about screening schedules. Call the Physician Concierge: 855-RAF-LINE for scheduling or information.