Balancing the Benefits and Harms of Low-Dose Computed Tomography Screening for Lung Cancer: Medicare's Options for Coverage
Authors: Renda Soylemez Wiener
Journal: Annals of Internal Medicine (2014)

Ideas and Opinions16 September 2014Balancing the Benefits and Harms of Low-Dose Computed Tomography Screening for Lung Cancer: Medicare's Options for CoverageRenda Soylemez Wiener, MD, MPHRenda Soylemez Wiener, MD, MPHFrom Boston University School of Medicine, Boston, and Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-1352 Annals Author Insight Video - Renda Soylemez Wiener, MD, MPH In this video, Renda Soylemez Wiener, MD, MPH, offers additional insight into her Ideas and Opinions piece, "Balancing the Benefits and Harms of Low-Dose Computed Tomography Screening for Lung Cancer: Medicare’s Options for Coverage." SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail On 30 April 2014, the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) convened to weigh the evidence for low-dose computed tomography (LDCT) screening for lung cancer. Many were shocked by the outcome: a vote of low confidence about whether the benefits of LDCT screening would outweigh harms among Medicare beneficiaries in a community setting. After all, LDCT screening was shown to reduce mortality in the NLST (National Lung Screening Trial) (1), a multicenter randomized trial enrolling more than 53 000 participants at high risk for lung cancer, and multiple guidelines now recommend LDCT screening for high-risk persons. Indeed, on the ...References1. Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, et al; National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365:395-409. [PMID: 21714641] CrossrefMedlineGoogle Scholar2. Moyer VA; U.S. Preventive Services Task Force.. Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160:330-8. [PMID: 24378917] doi:10.7326/M13-2771 LinkGoogle Scholar3. Pinsky PF, Gierada DS, Nath PH, Kazerooni E, Amorosa J. National Lung Screening Trial: variability in nodule detection rates in chest CT studies. Radiology. 2013;268:865-73. [PMID: 23592767] CrossrefMedlineGoogle Scholar4. Wiener RS, Schwartz LM, Woloshin S, Welch HG. Population-based risk for complications after transthoracic needle lung biopsy of a pulmonary nodule: an analysis of discharge records. Ann Intern Med. 2011;155:137-44. [PMID: 21810706] LinkGoogle Scholar5. Kozower BD, Sheng S, O’Brien SM, Liptay MJ, Lau CL, Jones DR, et al. STS database risk models: predictors of mortality and major morbidity for lung cancer resection. Ann Thorac Surg. 2010;90:875-81. [PMID: 20732512] CrossrefMedlineGoogle Scholar6. Bach PB, Mirkin JN, Oliver TK, Azzoli CG, Berry DA, Brawley OW, et al. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA. 2012;307:2418-29. [PMID: 22610500] CrossrefMedlineGoogle Scholar7. Roth JA, Sullivan SD, Ravelo A, Sanderson J, Ramsey SD. Low-dose computed tomography lung cancer screening in the Medicare program: Projected clinical, resource, and budget impact [Abstract]. J Clin Oncol. 2014;32(Suppl) Abstract no. 6501. Google Scholar8. Mazzone P. The rationale for, and design of, a lung cancer screening program. Cleve Clin J Med. 2012;79:337-45. [PMID: 22550076] CrossrefMedlineGoogle Scholar9. Arenberg D, Kazerooni EA. Setting up a lung cancer screening program. J Natl Compr Canc Netw. 2012;10:277-85. [PMID: 22308520] CrossrefMedlineGoogle Scholar10. McKee BJ, McKee AB, Flacke S, Lamb CR, Hesketh PJ, Wald C. Initial experience with a free, high-volume, low-dose CT lung cancer screening program. J Am Coll Radiol. 2013;10:586-92. [PMID: 23623708] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Boston University School of Medicine, Boston, and Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts.Acknowledgment: The author thanks Peter B. Bach, MD, MAPP, of the Memorial Sloan Kettering Cancer Center, and Michael K. Gould, MD, MSc, of Kaiser Permanente Southern California, for graciously providing feedback on an early version of this manuscript.Financial Support: By the National Cancer Institute (K07 CA138772) and the Department of Veterans Affairs.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1352.Corresponding Author: Renda Soylemez Wiener, MD, MPH, The Pulmonary Center, Boston University School of Medicine, 72 East Concord Street, R-304, Boston, MA 02118; e-mail, [email protected]edu.Author Contributions: Conception and design: R.S. Wiener.Drafting of the article: R.S. Wiener.Critical revision of the article for important intellectual content: R.S. Wiener.Final approval of the article: R.S. Wiener.Collection and assembly of data: R.S. Wiener.This article was published online first at www.annals.org on 24 June 2014. PreviousarticleNextarticle Advertisement Annals Author Insight Video - Renda Soylemez Wiener, MD, MPH In this video, Renda Soylemez Wiener, MD, MPH, offers additional insight into her Ideas and Opinions piece, "Balancing the Benefits and Harms of Low-Dose Computed Tomography Screening for Lung Cancer: Medicare’s Options for Coverage." FiguresReferencesRelatedDetailsSee AlsoLow-Dose Computed Tomography Screening for Lung Cancer Laura S. Welch , David Madtes , and Knut Ringen Low-Dose Computed Tomography Screening for Lung Cancer Renda Soylemez Wiener Low-Dose Computed Tomography Screening for Lung Cancer Laura S. 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Gould, MD, MS 16 September 2014Volume 161, Issue 6Page: 445-446KeywordsCancer screeningCancer treatmentComputed axial tomographyDisclosureLung and intrathoracic tumorsMedicareMortalitySmoking cessationThoraxVeteran care ePublished: 16 September 2014 Issue Published: 16 September 2014 Copyright & PermissionsCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...