When the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) recommended last week that Medicare not cover potentially lifesaving lung cancer screening, lung cancer experts criticized the decision, saying the panel had missed an opportunity to help prevent deaths from the leading cause of cancer death in the United States.
They weren't the only ones dismayed by the decision. Our Facebook followers posed a few questions themselves:
One wrote: "This doesn't make sense. Is it some kind of Dollars vs. Deaths decision?"
Another asked: "What can be done to challenge the decision?"
Dan Raz, M.D., co-director of the Lung Cancer and Thoracic Oncology Program at City of Hope, was among the expert presenters at the advisory committee meeting. He offers these answers to our Facebook followers:
Thanks for the questions, and for feeling so strongly about this very important issue. First, to offer a little background, this panel offers nonbinding recommendations to the Centers for Medicare and Medicaid Services (CMS). The U.S. Preventive Services Task Force – which, under the Affordable Care Act (or Obamacare) determines which services insurers must cover – recommends this same low-dose CT scanning for screening, and insurers will be required to cover it. The CMS will issue a proposed decision by November, and adopt a final decision in February 2015.
However, should Medicare not cover the screening, a huge portion of the population that is most at risk for lung cancer would lose access to lung cancer screening. I presented to the panel at its meeting last week, advocating for the screening to be covered because the science shows it's effective and it would save lives. This is an opportunity to transform lung cancer from something we can only sometimes cure to a disease we can usually cure, because finding it early is critical.
The panel, which did not include anyone who routinely treats lung cancer, said it based the decision on the fact that the members felt there was not enough evidence specifically addressing the Medicare population. I think they were also misinformed and exaggerated the risks of lung cancer screening.
The truth is, there is plenty of high-quality scientific data that tells us without a doubt screening for lung cancer with a low-dose CT scan is safe and would save lives – as many as 60 percent of lung cancer deaths among patients screened. The National Lung Screening Study was one of the best – if not the best – scientific trial ever conducted for any cancer screening. It’s the only cancer screening trial that I am aware of that found an absolute benefit in reducing the number of cancer deaths through screening. That trial found no difference in the survival between patients based on their age – patients of all ages, including Medicare age, benefited.
There’s also data to address the concern of finding cancer that would not have caused harm if left untreated. One of the concerns about broad mammography and PSA testing is that a certain number of cancers will be found that are indolent, and that the treatments pose more potential risks than the cancer itself. The Early Lung Cancer Action Program found that the screening is safe, and the risks are extremely minimal.
The bottom line is that lung cancer accounts for nearly 30 percent of all cancer deaths, largely because without screening, it isn’t discovered until it’s at an advanced stage. The panel had an opportunity to reduce that number significantly, and they failed to act on that opportunity. Personally, I think it was incredibly irresponsible.
The good news is, their decision is not final. There is time between now and when the Centers for Medicare and Medicaid Services make their final decision on this issue to make sure they understand the facts. There’s still time to make your voices heard.