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Affordable Care Act

New Recommendation: Older, Heavy Smokers Should Get Annual CT Scans, But Who Will Pay?

A national advisory group is recommending that heavy smokers of a certain age should get annual CT scans to check for lung cancer. The recommendation also applies to some people who used to smoke a lot, but then quit. But who should get the screening, and who will pay for it?


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This isn’t the first time the recommendation has surfaced for heavy smokers.

Last year, some doctors’ groups recommended getting the CT scan to look for small lung tumors. Catching tumors earlier makes them easier to treat.

But this time the recommendation comes from the U.S. Preventive Services Task Force.

That’s significant because under Obamacare, any screening recommended by that task force must be covered by insurance companies, with no co-payments.

Dr. Therese Bevers is the medical director of the Cancer Prevention Center at MD Anderson.  She says the decision will have huge implications.

“Now we’ll be seeing Medicare and all the other plans under the Affordable Care Act will now be offering this to their covered lives. So we’re going to see a lot more individuals who are receptive to undergoing lung cancer screening.”

MD Anderson currently charges $250 for the scan. It’s a CT scan with a low dose of radiation — the Task Force says to get it once a year.

So who should get the screenings?

People who are between ages 55 and 79, who currently smoke or quit in the past 15 years. But the smoking history has to be substantial — at least 30 “pack-years.”

You can calculate your “pack-years” by multiplying the number of years you have smoked by the number of cigarette packs per day.  

For example,

  • One pack a day times 30 years of smoking = 30 “pack years”
  • Two packs a day times 15 years = 30 “pack years”
  • Two packs a day times 20 years = 40 “pack years”
  • Half a pack (.5) a day times 20 years = 10 “pack years”

Bevers says the annual scans are not a good idea for less heavy smokers, because there are risks involved.

The biggest risk is a false positive — spotting something on the scan that might be a tumor, but could turn out to be benign.

“So you have to do either imaging, oftentimes every 6 months for 2 years, or you may actually have to do a biopsy, and doing a biopsy of the lung is not a small procedure. And it’s scary.”

The Task Force estimates that annual screenings could reduce lung cancer deaths in this group by 14 percent.

That’s good news, because more Americans die from lung cancer every year than any other type of cancer.

But Bevers wants people to remember one thing.

“Screening is not a replacement for quitting smoking. Screening will help detect disease early but it would be better not to get the disease in the first place.” 

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