NELSON lung cancer study encourages widespread screening, Medicare reimbursement

Annual lung screenings of older-aged current and former smokers should be conducted more regularly, potentially saving up to 65,000 lives in the U.S. each year, according to findings from the NELSON study presented at the 2018 International Association for the Study of Lung Cancer (IASLC) World Conference on Lung Cancer in Toronto, Canada.  

“Lung cancer kills more people each year than breast, colon and prostate cancers combined. Once implemented nationwide, this cost-efficient test would be the most effective cancer screening exam in history,” said Ella Kazerooni, MD, chair of the American College of Radiology (ACR) Lung Cancer Screening Committee and the ACR Thoracic Imaging Panel, in a prepared statement. “It is time for Medicare to provide adequate reimbursement for these exams, and for primary care providers and thoracic specialists to order them for their high-risk patients.” 

The NELSON study—a population based, controlled trial—included 15,792 participants split into two groups. One group was given baseline CT screenings and one, three and five and one-half years post-randomization. The other group served as controls.

Researchers found that annual lung cancer CT low-dose screening in high-risk patients reduced lung cancer deaths by 26 percent in men and up to 61 percent in women. The researchers also noted a 44 percent reduction overall if male and female participants were evenly split.  

The second largest trial of its kind, the results could be used to inform and direct future CT screening on an international level.   

“These findings show that CT screenings are an effective way to assess lung nodules in people at high risk for lung cancer, often leading to detection of suspicious nodules and subsequent surgical intervention at relatively low rates and with few false positives and can positively increase the chances of cure in this devastating disease,” said Harry De Koning, MD, PhD, of Erasmus MC in Rotterdam, Netherlands, in prepared statement by the IASLC.   

Study findings also encourage medical providers to implement lung cancer screening guidelines and prescribe exams for high-risk patients as part of their daily clinical practice. The ACR also noted that there should be an increase in Medicare reimbursement to support more widespread and accessible screening.  

“Shortly after covering these exams, the Centers for Medicare & Medicaid Services (CMS) slashed Medicare reimbursement to as little as $60 per exam in the hospital outpatient setting—less than half the Medicare provider reimbursement for a mammogram,” the ACR statement read. “This has restricted the number of facilities able to provide these lifesaving scans to large teaching hospitals. Funding for lung cancer screening needs to be greatly increased.”