The Centers for Medicare and Medicaid Services (CMS) recently announced that it updated its lung cancer screening eligibility guidelines for people covered by Medicare to be similar to the US Preventive Services Task Force (USPSTF). This means more Americans will be eligible to receive lifesaving lung cancer screenings at no cost, according to the American Lung Association.
In March 2021, the USPSTF expanded the guidelines for screening to include individuals ages 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. The CMS update includes individuals ages 50 to 77 years who have a 20 pack-year smoking history, currently smoke or have quit within the past 15 years, and are asymptomatic (no signs or symptoms of lung cancer). The USPSTF recommendation nearly doubled the number of individuals eligible for screening and has the potential to save significantly more lives than previous guidelines.
“Today’s announcement from CMS will give more people enrolled in Medicare access to lifesaving lung cancer screening. Screening for individuals at high risk is the only tool to catch this disease early when it is more curable,” said Harold Wimmer, President and CEO of the American Lung Association. “Unfortunately, only 5.7% of people who are eligible have been screened, so it’s important that we talk with our friends and family who are at high risk about getting screened.”
The updated Medicare recommendation is also an important step forward in addressing racial disparities associated with lung cancer, as the expanded criteria includes more individuals from Brown and Black communities. The Lung Association’s 2021 “State of Lung Cancer” report showed that people of color who are diagnosed with lung cancer face worse outcomes compared to white Americans because they are less likely to be diagnosed early, less likely to receive surgical treatment, and more likely to not receive any treatment.
While today’s announcement will significantly expand access to screening, the Lung Association recommended that CMS go further and expand eligibility to individuals up to 80 years of age, as well as remove the recommendation that individuals cease screening once they have stopped smoking for 15 years.
As a result of the Affordable Care Act, most private insurance plans will need to update screening coverage policies to reflect the updated USPSTF guidelines for plan years beginning after March 31, 2022.