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Point and Counterpoint |

POINT: Should Lung Cancer Screening by Chest CT Scan Be a Covered Benefit? YesCover Lung Cancer Screening? Yes

David F. Yankelevitz, MD
Author and Funding Information

From the Icahn School of Medicine at Mount Sinai.

CORRESPONDENCE TO: David F. Yankelevitz, MD, Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY 10029; e-mail: david.yankelevitz@mountsinai.org


FINANCIAL/NONFINANCIAL DISCLOSURES: The author has reported to CHEST the following conflicts of interest: Cornell University has had a licensing agreement with General Electric related to intellectual property on lung nodule analysis since 2006, and as a faculty member, Dr Yankelevitz was entitled to a share of the monies. He also is involved in research funded by the Flight Attendant Medical Research Institute through Mount Sinai regarding screening and risks of second-hand tobacco smoke. Dr Yankelevitz is director of the Lung Biopsy Service at the Icahn School of Medicine at Mount Sinai and an I-ELCAP Investigator.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(2):287-289. doi:10.1378/chest.14-2812
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Based on the US Preventive Services Task Force (USPSTF) grade B recommendation for lung cancer screening,1 commercial insurers operating through Affordable Care Act exchanges, with the exception of certain grandfathered plans, must cover individuals aged < 65 years who meet the USPSTF criteria for CT scan screening without copayments before the end of 2015.2 Thus, for these insurers, the question regarding coverage is settled; all that might be considered is whether the law is reasonable or whether the USPSTF made an improper recommendation. With regard to the Centers for Medicare & Medicaid Services (CMS), the decision will be based on whether they determine the test has a proven benefit to the covered population.3 In making this determination, it is necessary to understand the benefit in terms of potential lives saved compared with potential harms. With lung cancer being the leading cause of cancer death in the Medicare population, the stakes are high. However, should CMS decide not to provide this coverage, the incongruous result would be that those younger and at lower risk would be covered, whereas those at higher risk would not. In a somewhat analogous manner it would also allow for those aged > 65 years with means to pay on their own the opportunity to be screened, whereas poor and probably higher-risk populations would not have access.

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