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Point and Counterpoint |

COUNTERPOINT: Should Lung Cancer Screening by Chest CT Scan Be a Covered Benefit? NoCover Lung Cancer Screening? No

Katherine Courtright, MD; Scott Manaker, MD, PhD, FCCP
Author and Funding Information

From the Pulmonary, Allergy and Critical Care Division (Drs Courtright and Manaker), Hospital of the University of Pennsylvania (Drs Courtright and Manaker), and Department of Medicine (Dr Manaker), University of Pennsylvania.

CORRESPONDENCE TO: Katherine Courtright, MD, Pulmonary, Allergy and Critical Care Division, Hospital of the University of Pennsylvania, Gates Bldg, 806 W, 3400 Spruce St, Philadelphia, PA 19104; e-mail: katherine.courtright@uphs.upenn.edu


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST the following conflicts of interest: Dr Manaker has received fees as a grand rounds speaker, lecturer, consultant, and expert witness on documentation, coding, billing, and reimbursement from hospitals, physicians, departments, practice groups, professional societies, insurers, and various attorneys. In March 2011, he received $5,400 from Aetna Inc for consultation on diagnosis coding. He serves on the Hospital Outpatient Panel, a federal advisory commission to the Centers for Medicare & Medicaid Services; serves on the Contractor Advisory Committee for Novitas Solutions, Inc, a Medicare contractor; and chairs the Practice Expense Subcommittee of the American Medical Association, Specialty Society Relative Value Unit Update Committee. Dr Manaker also serves on the board of directors of ACCP Enterprises, Inc, a wholly owned, for-profit subsidiary of the American College of Chest Physicians. Dr Courtright has reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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):289-292. doi:10.1378/chest.14-2815
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Primarily detected in an advanced stage, lung cancer is the leading cause of cancer-related death in the United States and remains one of the most costly cancers, with dismal 5-year survival rates.1,2 The National Lung Screening Trial (NLST) demonstrated a 20% relative (1% absolute) reduction in lung cancer mortality by annual screening over 3 years with low-dose CT (LDCT) scanning compared with chest radiography (CXR).3 These results and the US Preventive Services Task Force (USPSTF) grade B recommendation4 fueled pressure for national insurance coverage of lung cancer screening with LDCT scanning. In contrast, the Medicare Evidence Development and Coverage Advisory Committee concluded that the apparent benefits of LDCT scan screening did not clearly outweigh the harms among Medicare beneficiaries. While awaiting the Centers for Medicare & Medicaid Services decision on coverage of LDCT scan screening (expected in 2015), we consider the extent and quality of the data currently available to make a reliable determination of the risk-benefit profile for this preventive service.

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