Stepped-Up Screening Would Uncover More Lung Cancers
But the scans and follow-up care would be expensive
Lung cancer is the leading cause of cancer death in the United States, usually because it has spread to other organs in the body by the time it is detected, Roth said.
The U.S. Preventive Services Task Force based its recommendation primarily on the findings from the National Lung Cancer Screening Trial, which demonstrated a 20 percent reduction of lung cancer deaths with CT screening compared to X-ray screening. CT (computed tomography) screening is an imaging procedure that uses special X-ray equipment to create a series of detailed pictures, or scans, of areas inside the body, according to the U.S. National Cancer Institute.
"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.