Lung cancer is the second most common cancer and the leading cause of cancer death in the United States.1 For all cancers, early detection is essential to better outcomes, and discovering lung cancer at an early stage leads to more successful treatment and a better prognosis.
In March 2021, the U.S. Preventive Services Task Force (USPSTF) updated their eligibility recommendations for low-dose computed tomography (LDCT) by lowering the pack-year amount and expanding the age range to allow more people to qualify for the screening.
- A 20 pack-year or more smoking history, and
- Smoke now or have quit within the past 15 years, and
- Are between 50 and 80 years old.
By updating these guidelines, the eligible population will almost double. Screening for lung cancer at an earlier age and in people with fewer pack-years of smoking will enable more women and minorities to be screened. These new guidelines represent an important change given the lung cancer risk profile for these groups. Both women and minorities tend to have less smoking history.2,3,4
Insurance company coverage and reimbursement will lag behind these guideline changes. Patients will need to utilize cash pay or work with their insurance companies directly prior to reimbursement. The Centers for Medicare & Medicaid Services guidelines do not yet align with the USPSTF recommendations and will need an updated National Coverage Determination.
Institutions that provide LDCT screening can make use of the time gap in coverage reimbursement to evaluate their readiness for higher patient volume or throughput. These institutions may have to revisit budgets and resources and make requests for additional staff, tools, and supplies that may be needed to manage the influx of patients who now qualify for this screening. Examining marketing efforts that can be deployed by the hospital or facility to the community to encourage patient awareness and participation will help drive participation rates. For more information on starting or expanding your comprehensive early detection program at your institution, please visit the GO2 Foundation Thoracic Oncology Business Model tool.
“Navigators have a unique opportunity to assist in addressing both healthcare facility and patient barriers that will allow the more diverse and eligible at-risk patients the opportunity to enroll in screening programs,” said Kim Parham, RN, BSN, CN-BN, Associate Director, Quality Care and Clinical Relations at the GO2 Foundation for Lung Cancer.
With the introduction of these new guidelines, lung cancer can be detected at an earlier stage, which will ultimately improve the current 5-year survival of 20.5%.
- Haiman CA, Stram DO, Wilkens LR, et al. Ethnic and racial differences in the smoking-related risk of lung cancer. N Engl J Med. 2006;354(4):333-342. doi:10.1056/NEJMoa033250.