American Lung Association Issues New Guidelines Favoring Chest CT

A critical component in getting more private insurers and possibly even Medicare to cover low-dose chest CT for lung cancer screening for current and former heavy smokers has arrived. The influential American Lung Association (ALA) has revised its guidelines on lung cancer screening to favor chest CT over chest X-ray. According to the new interim guidelines, individuals should not receive chest X-rays for lung cancer screening. Low-dose chest CT is recommended instead, but only in patients who match the criteria of the patients in the National Cancer Institute's influential National Lung Screening Trial (NLST) study, which was issued in August of last year. These criteria are:

• Being a current or former smoker, aged 55 to 74 years
• Having a smoking history of at least 30 pack-years
• Having no history of lung cancer

In the NLST study, screening for lung cancer with low-dose chest CT led to a 20 percent reduction in mortality. It was followed by an actuarial analysis in this month's issue Health Affairs that found that CT lung cancer screening also makes financial sense by lowering the cost of health care through catching cancers at earlier and more treatable stages. Last year, WellPoint became the first national insurer to cover low-dose CT lung cancer screening and the ALA recommendations will add pressure on other insurers to follow that lead. The ALA did express concern in its report that its new recommendations be handled appropriately. It has posted information for referring physicians, radiologists and patients to help ensure that this change does not lead to overutilization of CT screening for lung cancer. To access the new ALA guidelines, click here.