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Lung Cancer Screening Might Pay Off, Analysis Shows
Date:4/9/2012

organizations do not recommend lung cancer screening, or testing people before they have symptoms. The U.S. Preventive Services Task Force (USPSTF) does not support CT scan, chest X-rays or sputum cytology, in which mucus from the lungs is examined, because it states that there is not enough evidence that these tests reduce the number of lung cancer deaths.

On the other hand, lung cancer screening can detect benign tumors, leading to unnecessary invasive biopsies, and increases radiation exposure.

The USPSTF guidelines are probably the "single most important factor" for Medicare and private insurance companies in deciding whether or not to cover lung cancer screening, said Dr. William Black, a radiologist at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

And while neither the USPSTF nor insurance companies base their guidelines or coverage on costs, the USPSTF often looks at proxies to cost like the number of people needed to treat to have a certain effect, Black explained.

"Although in the past [cost] has not been a criteria for Medicare, many people expect that to change," Pyenson said. "Expenditure in health care overall is not sustainable."

In addition to the current study suggesting the cost-effectiveness of lung cancer screening, recent support for screening came in 2011 when results of the National Lung Screening Trial (NLST) were published. It found that getting CT scans every year for three years reduced lung cancer deaths by 20 percent compared with chest X-rays in current or former smokers between 55 and 74 years of age.

"I think it's certainly possible the USPSTF will endorse it, but if they did they would definitely restrict it to people like in the NLST," Black said, adding that he expects that the Task Force will update its guidelines sometime in 2013.

The current study simulated the effect of annual CT scans in people between 50 and 64 who had smoked at least a pack of cigarettes a day for 30 years. The
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