NSCLC Emerging as a Growing Problem Among Never-Smokers

“Lung cancers account for more than one-quarter of cancer deaths in the United States, and the disease is expected to kill nearly 160,000 Americans in 2016 alone. Early detection, which occurs in just 15% of cases, remains the best avenue to longterm survival; about half of patients found to have an early-stage lung cancer are alive 5 years after diagnosis, compared with fewer than 5% of patients whose cancers are detected after metastasis.

“The National Lung Screening Trial studied more than 53,000 patients and demonstrated that low-dose helical computed tomography (CT) is more effective at lung cancer early detection than standard chest X-rays, yielding—over an observation period of about 7 years—a 20% lower risk of dying from the disease. The trial enrolled only symptomless current or former smokers ages 55 to 74 who had a smoking history of 30 packyears (that is, a pack a day for 30 years, or 2 packs a day for 15 years) and who had been smokers within the prior 15 years.”

Lung Cancer Screening of Medicare-Eligible Patients Associated with Greater Benefits, Risks

“Screen-detected lung cancer prevalence, as well false-positive results, were higher among Medicare-eligible participants compared with younger participants, according to results of a secondary analysis of the National Lung Screening Trial.

“Initial results of the National Lung Screening Trial (NLST) demonstrated a 20% reduction in the risk for lung cancer with annual low-dose CT compared with chest radiography in high-risk adults aged 55 to 74 years. The findings served, in part, as the basis for the US Preventive Services Task Force’s recommendation — issued in December 2013 — that high-risk individuals aged 55 to 80 undergo annual lung cancer screening with low-dose CT.

“However, experts have debated whether the annual screens should be covered for Medicare beneficiaries, who comprised approximately 25% of the trial’s population (age 55 to 64 years, n=19,612; age 65 to 74 years, n=7,110). In April, the Medicare Evidence Development & Coverage Advisory Committee expressed low to intermediate confidence that the benefits of annual screening outweighed the potential risks in the Medicare population.”