CMS announced early last year that it would reimburse annual low-dose CT (LDCT) lung cancer screening for cigarette smokers and former smokers at high risk of developing the disease. Now, evidence out of Mayo Clinic suggests the criteria, as it currently stands, may be too exclusive.

CMS is currently only reimbursing annual LDCT lung cancer screening for individuals between 55 and 77 years of age who are either still smoking or have only kicked the habit within the past 15 years and still retain a smoking history of at least 30-pack-years, (or a 30-year pack-a-day average).

Establishing an accurate model for screening those at high risk of developing the disease was no small matter. Having screening criteria means faster detection and, consequently, big savings in terms of both lives and money, for the second most common cancer in the U.S.
The new research, published in the Journal of Thoracic Oncology, suggests that the predictive model approved last year needs some tweaking in order to be more effective. Specifically, screening should be made available to former smokers who quit smoking more than 15 years ago.

This isn't the first time Mayo Clinic has been involved in shedding light on the limitations of the U.S. Preventive Services Task Force's lung cancer screening standards. Last year, it published findings in JAMA that two-thirds of newly diagnosed lung cancer patients in the U.S. did not even meet the screening criteria.

The new research represents a deeper dive into that troubling statistic.

They set out to determine which specific lung cancer demographic is not being represented in the current screening criteria. The researchers pooled together two groups of individuals with lung cancer — a hospital cohort of 5,900 individuals and a community cohort of 850 residents in Olmsted County, Minnesota.

What they discovered was that 12 percent of the hospital cohort and 17 percent of the community cohort gave up cigarettes over 15 years prior to their diagnosis. For that reason, they would not qualify for a CT screening reimbursed by CMS under the current guidelines.

According to lead author, Dr. Ping Yang, a Mayo epidemiologist, the researchers were surprised at their own findings. She credited their surprise to a common assumption that the frequency of lung cancer becomes very low after an individual has abstained from smoking for such a lengthy period of time.

“We found that assumption to be wrong,” she said in a statement. “This suggests we need to pay attention to people who quit smoking more than 15 years ago, because they are still at high risk for developing lung cancer.”

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