When you hear the words “lung cancer,” you typically think two things. One, it’s bad; after all, it’s cancer and lung cancer is a particularly hard-to-treat disease. And two, the person who got it is or was a smoker. Your first thought is accurate. Lung cancer kills about 160,000 people a year in the U.S., more than breast, prostate and colon cancers combined, making it the leading cancer killer among both men and women of every racial and ethnic group. Your second thought, however, is false.
About 80 percent of all lung cancer deaths occur in people who never smoked or who quit smoking decades ago, according to Laurie Fenton Ambrose, president and CEO of the Lung Cancer Alliance. But the common misconception that only smokers die from lung cancer, and the implication that they therefore reap what they sow, may be coloring the debate about a new type of screening that could save many of these victims’ lives.
The test is called low-dose computed tomography (CT) scanning. It was part of the National Cancer Institute’s National Lung Screening Trial, and in November 2010 was halted because low-dose CT screening of high-risk populations had reached a prescribed limit of reducing mortality by at least 20 percent. Put simply, the test worked so well that the trial was called off. Since then, further modeling has predicted a practical reduction of 35 to 60 percent in lung cancer deaths, says Ambrose. By comparison, mammography’s death reduction benefit is just 15 percent.
The test is also cost-effective. Its cost per life saved (an analysis of public health value) is under $19,000, according to accounting consultant Milliman Inc., which published its analysis in the April 2012 edition of Health Affairs. Mammography’s value is $31,000 to $51,000, and colorectal cancer screening is $19,000 to $29,000.
While the latter two screenings are covered by health insurance, lung cancer screening, so far, is not. Medical guidelines and protocols are set, for the most part, by the United States Preventive Services Task Force (USPSTF), under the aegis of the Department of Health and Human Services. The USPSTF hasn’t approved the screening yet, and Ambrose, for one, is frustrated. “The [National Cancer Institute] halted the trial because it met its end point in 2010, but three years later, the USPSTF still has issued no ruling,” she says.
This is particularly troublesome because states are just now starting to set up their health insurance exchanges and determining basic coverage packages in relation to Affordable Care Act implementation. “We have been strident in our request for accelerated consideration for this, because states are moving forward, but there is still no guidance,” she says. “We are at a crossroads, because this is now a timing question.”
Why has the task force dragged its feet? It won’t say. It is notoriously opaque and rarely comments on its deliberations. “We ask them and just get standard boilerplate responses back,” Ambrose says. “I think they do not have an appreciation of the practical implications [of low-dose CT scanning]. A tragic and massive loss of life is occurring, and to not grasp what this really means is very disconcerting.”
Ambrose thinks it is based, at least in part, on the notion that only smokers get lung cancer. “It’s the only cancer that is blamed on the patient,” she says.
Lung cancer is also the least-funded by federal research dollars of the four leading cancer killers. The Lung Cancer Alliance is lobbying every state in hopes of getting low-dose CT scanning included in Affordable Care Act coverage, but without USPSTF approval, the odds are long. “I wish I were optimistic about this,” Ambrose says. “This test is a proven health benefit. But this is about politics, it’s not about science.”