Proportion of lung cancer cases caught early could double under proposed screening guidelines – but at a high cost

If Medicare implements new lung cancer screening recommendations for annual low dose CT scans for high-risk patients, a lot of lives could be saved, but the price-tag could be high, a new report suggests.

Researchers projected that about 55,000 more lung cancer cases, many of them early stage, will be detected over a five-year period. But implementing the new U.S. Preventive Services Task Force guidelines could result in a cost increase of $9.3 billion over the next five years, researchers predicted in a report released ahead of the annual meeting of the American Society of Clinical Oncology.

The U.S. Preventive Services Task Force recommended annual low dose CT screening in healthy people aged 55 to 80 who have a history of smoking a pack a day for 30 or more years, following a report from a large study showing that this strategy might reduce deaths from lung cancer by 20 percent.

Lung cancer is the leading cause of cancer death in the United States. That’s mainly because lung cancers often aren’t caught until they are at a very late stage, said Dr. Josh Roth, study co-author and a postdoctoral fellow at Fred Hutchinson Cancer Research Center. Roth is also part of the Hutchinson Institute for Cancer Outcomes Research.

Patients who are diagnosed at distant stage have a 4 percent five-year survival rate, Roth said. And, currently, 57 percent of patients are diagnosed at this stage.

Compare those odds to a patient who is diagnosed with localized cancer which comes with a five-year survival rate of 54 percent.

“If we can periodically look for and detect cancer earlier that allows for potentially curative surgery, and generally, a much better prognosis,” Roth said.

The task force’s guidelines will be implemented by insurers participating in the Affordable Care Act, Roth said. But Medicare hasn’t yet signed on.

“There are some legitimate concerns,” Roth said. “Most important among them is the fact that the trial involved relatively few patients 65 years of age or older, which is the group that would be covered by Medicare.”

With Medicare officials mulling over the decision, Roth and his colleagues thought it might help if they could figure out what the benefits and cost of implanting screening might be.

“We determined that if it was implemented, over five years 54,900 more people would be diagnosed, the vast majority at Stage 1,” Roth said.

That’s an increase in the proportion of cancers diagnosed at early-stage from 15 percent to 33 percent.

But the cost would be significant.

“Over five years, there would be about $5.6 billion more spent on low dose imaging, $1.1 billion for diagnostic workups, and $2.6 billion more in cancer care expenditures,” Roth said. “So, that all adds up to $9.3 billion in additional expenditure over five years.”

Those costs will need to be offset either by a reduction of other services or by an increase in premiums, Roth said. “Let’s say there is no cost offset elsewhere, that means that there will need to be an increase of $3 per member per month to cover this,” he added. “That’s the bottom line on this.”

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Linda Carroll is a longtime health and science writer. She is coauthor of "The Concussion Crisis: Anatomy of a Silent Epidemic."

Solid tumors, such as those of the lung, are the focus of Solid Tumor Translational Research, a network comprised of Fred Hutchinson Cancer Research Center, UW Medicine and Seattle Cancer Care Alliance. STTR is bridging laboratory sciences and patient care to provide the most precise treatment options for patients with solid tumor cancers.