A new lung cancer test may benefit heavy smokers older than 65 years, as demonstrated by a study reanalyzed by investigators at the National Cancer Institute, as Medicare is raising questions about the coverage of scans. The current health-care law doesn’t demand Medicare to pay for the exams, which can cost between $100 to $400, and a spokesman of the national social insurance program said that a decision about covering scans will be announced by the beginning of November.
Late detection of lung cancer may be one of the reasons for why the disease kills nearly 160,000 people every year in the United States alone. This is a reversal of earlier findings, as earlier diagnostic methods demonstrated in a 2011 study that low-dose CT scans of the lungs of people at especially high risk due to heavy smoking were able to reduce their chances of dying from lung cancer by 20 percent.
The U.S. Preventive Services Task Forces recently recommended that people age 55 years and older who smoke a pack of cigarettes a day for 30 years should receive yearly tests, which demanded private insurers to start covering the scans with no co-pays under the Affordable Care Act. However, Medicare is questioning the decision, as the national social insurance program questions the test benefits for senior patients.
The question raised was that scans may be performed in older patients that already suffered from other health problems due to the age and were not able to withstand cancer treatment if an early tumor were found. It was also pointed out that in the U.S. 70 per cent of the lung cancer diagnosed was in people with 65 years old or more.
In the study conducted at National Cancer Institute, only a quarter of the patients were older than 65 years and no one was older than 76 years. Therefore, Paul Pinsky, the lead researcher and his team, reanalyzed the data to confirm the effects of scan screening in older patients, having concluded that scans involve trade-offs for older ad middle aged-groups. The senior participants of the study were healthier than average, as explained by Pinsky.
“The main thing is, you don’t want to get screened if you’re not going to be able to benefit from it,” Pinsky said. “Certainly for the healthy subgroup of 65-plus, it seems like the harms are maybe just marginally greater than for a younger population, and in one sense you have a greater opportunity for absolute benefit.”
When the investigator talks about trade-offs, he is mentioning situations such as false-alarms, which would need invasive follow-up tests. He noted that older participants registered higher rates of false-positive scans during the three years of tests, with a difference of 28 per cent to 22 per cent. One prevention meant screening 245 older patients, while the same is true in 364 middle-aged patients.
From the patients who had cancer, the senior and the middle-aged group were as likely to undergo surgery, and the five-year survival rate was 67.5 per cent for the under-65 patients, compared to 66.7 per cent for 65- to 69-year-olds and 56.5 per cent for those older than 70.