Centers for Medicare & Medicaid Services Expands Coverage for Lung Cancer Screening

The Centers for Medicare & Medicaid Services (CMS) announced a national coverage determination that expands coverage for lung cancer screening with low dose computed tomography (LDCT) to improve health outcomes for people with lung cancer. 

Last year, the U.S. Preventive Services Task Force (USPSTF) updated its recommendation statement for annual screening for lung cancer with LDCT to include a broader patient base. The CMS expanded coverage adopts the USPSTF recommendation. 

The USPSTF recommends annual lung cancer screening with LDCT in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.

The CMS final decision also simplifies requirements for the counseling and shared decision-making visit. In addition, the decision removes the requirement for the reading radiologist to document participation in continuing medical education and notes that the reading radiologist must be board certified or have board eligibility. CMS also added a requirement back to the criteria for radiology imaging facilities to use a standardized lung nodule identification, classification and reporting system.

RSNA supports the USPSTF recommendation and CMS expanded coverage, which have potential to mitigate racial disparities in screening eligibility.

“RSNA is committed to improving patient care and increasing health equity,” said Jeffrey S. Klein, MD, a renowned expert in lung cancer detection and staging, and the RSNA Board of Directors liaison for publications and communications. “Expanding the guidelines to include a broader, more diverse patient base is an important step to protect the health of vulnerable populations.”

The USPSTF recommendations are expected to expand the relative screening eligibility by 87% overall, including 107% in non-Hispanic Black adults and 112% in Hispanic adults, according to a USPSTF statement. Additionally, the relative percentage of women eligible for screening would increase by 96%.

Lung cancer is the second most common cancer and the leading cause of cancer death in the U.S. In 2020, an estimated 228,820 persons were diagnosed with lung cancer, and 135,720 persons died of the disease.

The most important risk factor for lung cancer is smoking. Increasing age is also a risk factor for lung cancer. Lung cancer has a generally poor prognosis, with an overall 5-year survival rate of 20.5%. However, early-stage lung cancer has a better prognosis and is more amenable to treatment.

The updated USPSTF recommendation replaces the 2013 statement that recommended annual screening for lung cancer with LDCT in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. 

For More Information

Visit the U.S. Preventive Services Task Force.

Visit the Centers for Medicare & Medicaid Services.