Stepped-Up Screening Would Uncover More Lung Cancers
But the scans and follow-up care would be expensive
"This is unusual in that we have a very clear trial that we all agree shows screening saves lives," Brawley said. "It's illustrative of a problem in American medicine, where at some point in time we're going to have to realize that medical costs are growing and come to grips with that."
The new study shows that the screening program will catch lung cancer at an earlier stage, Roth said, but that it comes at a cost.
The researchers based their model on the task force's recommendation, and assumed that about one in five high-risk patients will be offered lung cancer screening.
They used historic data from the initial rollout of mammography screening to evaluate three different possible scenarios -- a most likely scenario in which 50 percent of patients offered lung cancer screening would undergo the procedure each year, as well as a low-use scenario of 25 percent of patients and a high-use scenario of 75 percent of patients.
In the most likely screening-use scenario, the screening would yield 11.2 million more LDCT (low-dose computed tomography) scans and result in 54,900 more lung cancers detected over five years, compared to no screening. The proportion of early stage diagnoses would increase from 15 percent to 33 percent.
But it comes with a cost. The total five-year Medicare expenditure for LDCT imaging, diagnostic workup and cancer care would be $9.3 billion, or about $3 per month for every Medicare member.
Those costs break down as $5.6 billion more for imaging, $1.1 billion more for diagnostics, and $2.6 billion more in cancer care, the study authors said.
In the low- and high-screening use scenarios, the total five-year Medicare expenditure would be $5.9 billion and $12.7 billion, or a $1.90 and $4.10 monthly premium increase per Medicare member, respectively.
Brawley said policymakers have an obligation to weigh questions such as whether the money spent on lung cancer screening would be better spent on smoking cessation, which would prevent lung cancer altogether.
"Personally, I have a problem with that statement, because that writes off people in their 50s and 60s who are at risk for lung cancer," Brawley said. "I don't have the answers."
Dr. Harvey Pass, chief of thoracic oncology at the Perlmutter Cancer Center of NYU Langone Medical Center in New York City, said the new findings provide a strong argument for Medicare covering the cost of lung cancer screening.
"In the United States, prices for a carton of cigarettes can vary from $30 to $70 for a brand name," Pass said. "For the cost of one carton of cigarettes, an individual would be able to afford the monthly premium, according to this study, for Medicare to cover the added expense of lung cancer screening."