UF Health Lung Cancer Program: Lung Cancer Screening Information

Lung cancer kills more Americans than the next four leading cancers combined, including breast, colon, pancreatic and prostate cancers. Each year, close to 160,000 people die of lung cancer. Early detection of lung cancer is important because it leads to increased survival rates and a decrease in lung cancer related deaths. Cure rates improve when lung cancer is detected and treated in its earliest phase. Early detection through screening can increase the 5-year survival rate for a detected stage I lung cancer to nearly 90%.

The National Lung Screening Trial (NLST) has now shown that screening individuals at high risk for lung cancer with an annual low-dose computed tomography (CT) of the chest can save lives.

 In the NLST

  • One life was saved for every 320 high-risk persons screened with low dose CT resulting in a 20 percent lung cancer-specific mortality benefit versus annual chest X-rays. 
  • The benefits of an annual lung cancer screening scan exceeds the benefits of breast cancer screening with mammography

Recently, the Centers for Medicare & Medicaid Services (CMS) issued a final national coverage determination that provides for Medicare coverage of screening for lung cancer with low dose CT.

“This is the first time that Medicare has covered lung cancer screening. This is an important new Medicare preventive benefit since lung cancer is the third most common cancer and the leading cause of cancer deaths in the United States,” said Dr. Patrick Conway, chief medical officer and deputy administrator for innovation and quality for CMS.

Medicare will now cover lung cancer screening with low dose CT once per year for Medicare beneficiaries who meet all of the following criteria:

  • ages 55-77, and are either current smokers or have quit smoking within the last 15 years;
  • tobacco smoking history of at least 30 “pack years” (an average of one pack a day for 30 years)
  • receive a written order from a physician or qualified non-physician practitioner that meets certain requirements.

Medicare coverage includes a visit for counseling and shared decision-making on the benefits and risks of lung cancer screening. The national coverage determination also includes required data collection and specific coverage eligibility criteria for radiologists and radiology imaging centers, consistent with the National Lung Screening Trial protocol, U.S. Preventive Services Task Force recommendation, and multi-society multi-disciplinary stakeholder evidence-based guidelines.

“We believe this final decision strikes an appropriate balance between providing access to this important preventive service and ensuring, to the best extent possible, that Medicare beneficiaries receive maximum benefit from a lung cancer screening program,” Conway said.

It is also important to know that, as in any screening, there are risks:

  • “False positive” findings: CT scanners can see “spots” on the lung as small as a grain of rice. If the scan picks up any findings suspicious for lung cancer, it is called a “positive screen.”  About 95% of these “spots” are not cancer and do not require a biopsy however this may require repeating the scan at defined intervals to look for changes in size and shape of the “spots”.
  • Anxiety: If cancer is suspected, additional testing will be required to confirm the results. Anxiety during this process is common.
  • Unnecessary surgery: Even with all these precautions, some nodules - about 0. 5% - that are not cancerous may end up being removed by unnecessary surgery. All lung surgery carries significant risk and after effects.
  • Radiation exposure: Some people worry about radiation exposure from lung cancer screening. Screening scans that check people who have no symptoms for lung cancer are given at low dose, which means that the level of radiation used is very low (similar to the radiation dose in a mammogram). Follow-up scans that may have to be done to determine if any change or growth has occurred are at the same low-dose.

Our multidisciplinary lung nodule team will work closely with your medical provider to avoid unnecessary biopsies and maximize the benefits of lung cancer screening.