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Who Should Get a CT Scan to Screen for Lung Cancer?
Date:7/1/2011

death rate was 20 percent lower in those who got the CT scans than in those who had X-ray screening.

Study participants consisted of people who'd smoked at least 30 "pack years" -- meaning, current or former smokers who'd smoked an average of one pack a day for at least 30 years, or two packs a day for at least 15 years.

According to the U.S. National Cancer Institute, screening with a spiral CT costs from $300 to $1,000, which means insurers and policy-makers have to consider who is going to pay for it, and who should receive one, Sox said.

Could CT scans benefit people who are at a somewhat higher risk of lung cancer, but who don't meet the 30 "pack years" threshold? Would screening every other year cost half as much and work just as well? Is three years long enough to screen someone, or does the screening need to be done every year for as long as the person is alive?

Also, in this era of rising health-care costs, what is the responsibility of insurance companies or Medicare to pay for the test? And is it more cost-effective to put resources into preventing smoking and smoking-cessation programs instead of paying for CT scans?

While there are about 7 million people in the United States who meet the "heavy smoker" criteria used in the trial, there are 94 million current and former smokers, according to the study authors.

"Those are big questions in terms of costs, when you are talking about 7 million to 94 million people," Sox said.

Dr. Therese Bevers, a professor of clinical cancer prevention at M.D. Anderson Cancer Center in Houston, urged people with a shorter smoking history not to rush out and demand a CT scan. The study results showed benefit specifically for people who'd been heavy smokers for a long time.

"It's not appropriate for every smoker, such as the more casual or short-term user. Thirty pack years is a very significant smoking history," Bevers said. "If you smoked when you were in college 20 years ag
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