Making the case for lung cancer screening

U-M radiologist involved in national effort to gain Medicare coverage for lung cancer CT screening

Ella A. Kazerooni, M.D., director of cardiothoracic radiology at the University of Michigan Health System

Ella A. Kazerooni, M.D., director of cardiothoracic radiology at the University of Michigan Health System

An op-ed piece published in the Wall Street Journal asks a provocative question: “If you could save thousands of lives, would you do it?”

The article was co-written by Ella A. Kazerooni, M.D., director of cardiothoracic radiology at the University of Michigan Health System. It goes on to urge Medicare to cover lung cancer screening.

The National Lung Screening Trial, a large-scale clinical trial funded by the National Cancer Institute, found that among 53,000 heavy smokers at high risk of lung cancer, CT screening demonstrated a 20% reduction in lung cancer deaths. The results led to the U.S. Preventive Services Task Force (USPSTF), the government body that evaluates cancer screening tools, to recommend lung cancer screening for people age 55-80 who have smoked at least 30 pack years, and are either current smokers or quit within the last 15 years.

Under the Affordable Care Act, the UPSTF recommendation requires insurance companies to include the service as an essential covered benefit. This will become effective for lung cancer screening in January 2015. CMS, which provides health care benefits to those 65 and older through Medicare, is not covered under the terms of the Affordable Care Act, and is currently in the process of making its decision about covering lung cancer screening.

We talked to Dr. Kazerooni about some of the work that’s happening to implement lung cancer screening widely.

mCancerTalk: What does the support look like for lung cancer screening?

Dr. Kazerooni: I chair the Committee on Lung Cancer Screening for the American College of Radiology, and have worked to forge alliances with major professional and advocacy organizations to move forward our collective desire to see CMS issue a favorable coverage decision later this year. We began this work with major stakeholders from the Society of Thoracic Surgeons, the Lung Cancer Alliance and the American Association of Physicists in Medicine.

Recently, we have grown our coalition to include important stakeholders from the American Thoracic Society and the American College of Chest Physicians, who were part of our most recent visit to meet with CMS on June 19. Collectively we represent the physicians who perform and interpret lung cancer CT screening examinations, and manage or oversee the management of any abnormalities detected by screening. This will help to maximize the benefit of screening and minimize harms.

mCancerTalk: How do we make sure that lung screening is done right and that patients are not having too many unnecessary follow-up scans or tests?

Dr. Kazerooni: The breast cancer screening community has a set of guidelines maintained by the ACR known as BI-RADS that have been around for 20 years. The BI-RADS tools provide a framework for radiologists interpreting mammograms. It outlines how to categorize findings according to the probability of cancer, and what associated next steps should be. The guidelines also allow providers to oversee the quality of the services provided.

Drawing on the breast cancer screening experience, the ACR created the same thing for lung screening, called Lung-RADS. We developed this to provide structured reporting, management and audit tools for practices across the country to follow and benchmark their performance to. Lung-RADS provides a common language.

mCancerTalk: What is happening at the state and local level related to lung cancer screening?

Dr. Kazerooni: Doug Arenberg (M.D., associate professor of internal medicine) and I are on a task force through the Michigan Cancer Consortium to educate providers and help bring lung screening to Michigan residents. Within the University of Michigan, we’re working with colleagues in population health to educate our primary care physicians about who to screen, when to screen and how to screen. Dr. Arenberg has also assembled a group of several dozen health care facilities in Michigan and northern Ohio that share best practices for lung cancer screening, so we can all do the best by our patients.

We have a lung screening clinic at U-M that adheres to guidelines set by the National Comprehensive Cancer Network for screening high-risk patients.

mCancerTalk: What do you hope happens?

Dr. Kazerooni: We have three major goals:

  1. Outright coverage of lung cancer screening CT for individuals age 55-80 who have smoked at least 30 pack years and are either current smokers or quit within the last 15 years.
  2. Coverage with evidence decision for people who don’t meet those criteria but may be at high risk of lung cancer for other reasons, including people with other smoking-related cancers, certain occupational exposures or a family history of lung cancer.
  3. A requirement that smoking cessation services be part of all lung cancer screening programs.

CMS is required to post its draft coverage decision by Nov. 10, after which there will be a 30-day comment period. We urgent patients and providers to be active supporters of this life-saving health measure for the No. 1 cause of cancer death in the United States today.

Take the next step:

routine lung cancer screeeningElla A. Kazerooni, M.D., M.S., is professor of radiology, associate chair for clinical affairs and director of cardiothoracic radiology at the University of Michigan Health System. Her research focuses on the development and evaluation of advanced imaging technologies as applied to diseases of the cardiothoracic organs. This includes evaluating the technologies at several levels, from safety to validity and reliability, reader agreement and impact on medical decision making. Dr. Kazerooni is chair of the American College of Radiology’s committee on lung cancer screening and vice chair of the National Comprehensive Cancer Network’s lung cancer screening panel.

University of Michigan Comprehensive Cancer CenterThe University of Michigan Comprehensive Cancer Center’s 1,000 doctors, nurses, care givers and researchers are united by one thought: to deliver the highest quality, compassionate care while working to conquer cancer through innovation and collaboration. The center is among the top-ranked national cancer programs, and #1 in Michigan for cancer patient care. Seventeen multidisciplinary clinics offer one-stop access to teams of specialists for personalized treatment plans, part of the ideal patient care experience. Patients also benefit through access to promising new cancer therapies.