Medical Research: What is the background for this study? What are the main findings?
Dr. Black: Lung cancer is the leading cause of cancer related death in the U.S., killing more people than cancers of the colon, breast, and prostate combined. In 2011, the National Lung Screening Trial (NLST) demonstrated that screening for lung cancer with low-dose CT could reduce lung cancer mortality by 20% in adults at high risk for the disease. Since then, several medical organizations have recommended that eligible adults be offered screening. The U.S. Preventive Services Task Force (USPSTF) released a grade B recommendation for low-dose CT screening in December 2012, which means that private insurers must cover the cost of screening by January 1, 2015. The Centers for Medicare and Medicaid (CMS) is expected to issue a final decision on national coverage for CT screening in February 2015 and a preliminary decision for public comment on November 10, 2014.
Medical Research: What are the main findings?
Dr. Black: The main finding in our paper was that CT screening for lung cancer appears to have been cost-effective in the NLST, with an incremental cost-effectiveness ratio of about $81,000 per quality-adjusted life year gained. However, this ratio varied widely in the subset and sensitivity analyses. In other words, for CT screening to be cost effective, the right patients must be offered screening, those who accept must be screened in the proper manner, and treatment must be safe and effective.
Medical Research: What should clinicians and patients take away from your report?
Dr. Black: That CT screening for lung cancer can be cost-effective if it is properly implemented. However, screening should only be offered to those who are eligible, patients should be well informed of the expected benefits and harms, and the screening should take place at a facility with a high level of expertise CT screening and coordinated care. For current smokers, the most important thing they can do is stop smoking.
Medical Research: What recommendations do you have for future research as a result of this study?
- Close monitoring of screening implementation in the U.S.
- Further investigation of informed decision making.
- Further investigator of CT interpretation and patient management.
William C. Black, M.D., Ilana F. Gareen, Ph.D., Samir S. Soneji, Ph.D., JoRean D. Sicks, M.S., Emmett B. Keeler, Ph.D., Denise R. Aberle, M.D., Arash Naeim, M.D., Timothy R. Church, Ph.D., Gerard A. Silvestri, M.D., Jeremy Gorelick, Ph.D., and Constantine Gatsonis, Ph.D. for the National Lung Screening Trial Research Team