September 25, 2018

Nelson Lung Cancer Screening Study Confirms NLST Results

The Nelson Study, presented at the IASLC World Conference on Lung Cancer, showed that annual lung cancer screening with low-dose computed tomography in high-risk patients reduced lung cancer deaths by 26 percent in men and up to 61 percent in women (up to a 44 percent reduction overall if male and female cohorts were evenly split). Given that the American Cancer Society predicts 160,000 lung cancer deaths in the US in 2018, widespread screening could save up to 65,000 American lives each year. 

The Nelson study reinforces three important points about lung cancer screening policy:

  1. Screening older current and former smokers each year should be done far more widely
  2. Medical providers must become familiar with lung cancer screening guidelines and prescribe these exams for appropriate high-risk patients
  3. Drastically low Medicare reimbursement must be increased to support widespread screening

“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. 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,” said Ella Kazerooni, MD, FACR, chair of the American College of Radiology Lung Cancer Screening Committee and ACR Thoracic Imaging Panel.

Physicians Not Adhering to Guidelines

Unlike breast and colon cancer screening, a patient’s primary care physician must approve the patient for a lung cancer screening exam during a shared-decision making visit. Many of these providers are unaware of the exams – or not informed on the benefits of these scans.

Tests are Under-Covered by Medicare

Shortly after covering these exams, the Centers for Medicare & Medicaid Services 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. 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.

False Positives Overstated

Updates to Lung-RADS™ - a quality assurance tool to standardize lung cancer screening CT reporting and management recommendations – has reduced false positive rates by 75 percent compared to previous studies. This process will improve, but only with an adequate number of patients to screen and review. Previous psychological studies show that patient concern over cancer screening false positives is short-term with no lasting effects.

“The massive lifesaving benefit of these exams, and the threat to older current and former smokers from this disease, outweighs any potential harms to the defined screening population. By reimbursing at a realistic rate, Medicare has a real opportunity to help save lives now,” said Kazerooni.

For more CT lung cancer screening information, visit