This summer, the New England Journal of Medicine published the results of a government-funded trial that found screening current and former heavy smokers with low-dose CT scans was tied to a 20% reduction in lung-cancer deaths.
Now, the study is starting to have a concrete impact: insurer WellPoint, with around 34 million members, says it will start covering the tests based on its findings. It’s the latest twist in a long debate about using the scans to detect lung cancer, an idea that has been the subject of clashing research findings over the years.
Under WellPoint’s new policy, CT scans for lung-cancer screening will be covered for people who match the characteristics of those involved in the National Lung Screening Trial.
To have screening covered, beneficiaries must have smoked at least the equivalent of a pack a day for 30 years and be between the ages of 55 and 74, among other traits. The study found that among participants who were given three annual CT scans, there were 247 deaths from lung cancer per 100,000 person-years, while among the group who got X-rays instead, there were 309.
“This was the first time a really well-done study showed you could save lives by screening with this technique,” John Whitney, a WellPoint medical director, tells the Health Blog. But, he says, “based on the potential downsides, we think the evidence only supports screening for the population they studied and showed a benefit in.” He points to the radiation involved in CT scans, as well as the risk of false positives, but said the cost of the scans wasn’t a factor in WellPoint’s decision.
The new WellPoint policy promises coverage of annual scans for three years, which is what was provided in the study. Whitney says the policy is expected to evolve as further evidence emerges on what’s the best regimen of screening scans.
The American Society of Clinical Oncology, the American Thoracic Society and the American College of Chest Physicians are developing a clinical practice guideline for lung-cancer screening, which ASCO says will come out early next year.
So far, it’s not clear how many other insurers are ready yet to back CT screening for lung cancer.
Cigna said it considers the scans for lung-cancer screening experimental and unproven “based on the scientific data available” and believes “the impact on mortality is unknown.” Aetna said it also views this use of the scans as experimental, and it is considering the new study as well as any new guidelines that will emerge from federal health agencies including the U.S. Preventive Services Task Force, which currently says there’s not enough evidence to recommend for or against screening asymptomatic people using low-dose CT or any other method. (The group’s recommendations were last updated in 2004.)
UnitedHealth Group said it follows guidelines from the National Cancer Institute and the preventive services task force, and thus doesn’t currently cover CT for lung-cancer screening, but “we continually monitor clinical research” related to the topic.
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