Few smokers get life-saving scans
She didn’t know there had been an ongoing controversy about whether the low-dose CT scans should be covered by Medicare or whether they cause more trouble than they prevent.
But Bettye Givens, from south Kansas City, Missouri, knew she wanted to be tested for lung cancer, if possible, when she visited her doctor last October.
As it turned out, Givens, 72, is exactly the sort of patient that the federal government decided in 2015 should get a low-dose CT scan, covered by Medicare: people age 55 to 77 who have a 30 “pack year” smoking history — meaning they’ve smoked a pack a day for 30 years, two packs a day for 15 years, three packs a day for 10 years, etc.
That coverage recommendation was based on a large, multiyear study that found a 20 percent reduction in lung cancer deaths among people roughly that age and smoking history who got the scans.
The American Lung Association estimates that about 9 million people nationwide fit the criteria. But hardly anyone is getting the scan, even within the high-risk group.
Andrea McKee, a radiation oncologist in Massachusetts and scientific adviser to the lung association, said that a patient registry shows about 230,000 of the 9 million have been scanned: about 2.5 percent.
Why? McKee said in many cases, their doctors just might not know it’s an option.
But Nirmal Veeramachaneni, a thoracic surgeon at the University of Kansas Hospital, said there’s more at play. Veeramachaneni, who wrote an article about the low-dose CT scan in
a journal for Kansas City doctors, said there’s a shortage of qualified lung cancer screening programs outside of major metro areas.
There’s a good reason for that, he said: It’s hard for small, rural medical centers to replicate the results of the national study.
Veeramachaneni said the federal Centers for Medicare and Medicaid Services recommended covering the screening against the advice of its own advisory committee on new science and technology, which said covering the scans would lead to unequal care depending on where patients live.
Givens was referred to KU Hospital, where the low-dose CT scan turned up two suspicious nodules, one in each lung. Veeramachaneni excised bits of both using a minimally invasive surgery. One was a false positive, but the other was cancerous, so Veeramachaneni went in for a second procedure to excise it.
It was Stage 1 cancer, so Givens didn’t need chemotherapy and her prognosis is good. If it had progressed to later stages in which physical symptoms appear, her chances of survival would have dropped dramatically.
“I feel like the scan is very, very important,” Givens said. “It’s the difference between life and death and I think all persons should be able to have access to have this done.”