CANCER

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Preventive lung cancer screenings coming

Local health systems are working to enhance their lung cancer screening programs driven by evidence that better, and earlier, detection can shrink death rates by 20 percent.

Sharp HealthCare, Scripps Health, UC San Diego Health System, Kaiser Permanente and Tri-City Medical Center are implementing, or considering implementing, programs that would use yearly CT scans of smokers and former heavy smokers. These smokers, a recent national study found, are at heightened risk for developing lung cancer, a disease that kills 160,000 Americans per year.

The heightened interest in lung cancer screening comes as the U.S. Preventive Services Task Force considers a recommendation that, if adopted, would require health insurance companies to cover yearly CT scans for patients whose age and smoking history puts them at risk.

The task force recommends yearly screenings for patients age 55 to 79 who have a 30 “pack year” smoking history and are either current smokers or have quit within the past 15 years.

A “pack year” is equivalent to smoking an average of one pack of cigarettes per day for a year. It is possible to rack up multiple pack years in a single calendar year by smoking multiple packs per day. For example, a person who smoked two packs a day would reach 30 pack years in 15 calendar years.

The task force cites a landmark study, published by the National Cancer Institute in 2011, as the main reason for its new lung cancer screening recommendation. The study found that, for 53,454 current or former heavy smokers, a low-dose CT scan was more effective than a traditional chest X-ray at detecting lung cancer. Those patients whose CT scans came back positive have a 20 percent lower chance of dying from the lung cancer that was detected.

That’s not news to Dr. Siavash Jabbari, a radiation oncologist with Sharp’s Barnhart Cancer Center in Chula Vista. He said the cancer center had been putting together its own screening program for about six months when the task force’s recommendation was published on July 30.

He said Sharp is moving forward aggressively with its plans, reaching out to primary care doctors and sharing the criteria for patients to be scanned.

“Lung cancer is a bigger killer than breast, prostate and colon cancer combined,” Jabbari said. “Our demographic down here is that patients tend to be smokers. Whether or not insurance companies or private payers are on board, we felt that we should at least start offering it. The survival benefit is so big that it seemed almost difficult not to.”

Sharp seems to be the farthest along with its plans in San Diego County. Stephen Carpowich, a spokesman for Scripps Health, said in an email that the health system’s lung cancer task force is working on a pilot program at a single hospital.

“Based on findings from this pilot program, this service may be expanded more broadly to patients at other Scripps facilities,” Carpowich said.

Tri-City Medical Center in Oceanside is also planning to roll out a screening program in November, an official said. UC San Diego Health System and Kaiser Permanente said they are also considering programs, but have nothing to announce yet.

Dr. Norman H. Edelman of the American Lung Association said that until now there has been no consistent standard of care for lung cancer screenings. Some doctors already order CT scans if they suspect cancer, while others don’t. Some, he said, still use traditional X-rays even though they have been shown to be inferior to CT scans.

“For sure it’s done, but it’s not part of anybody’s standard of care,” Edelman said. “You won’t find it in any of the guidelines of any professional society.”

Who pays for the scans is a big part of the implementation puzzle. A spokesperson with the U.S. Department of Health and Human Services said the Affordable Care Act of 2010 requires insurance companies to cover all preventive services that the task force gives an “A” or “B” rating.

Because the task force rated the lung cancer scans a B, insurance companies would be required to provide the service one year after it is given final approval, which is expected to occur in three to six months.

The task force uses a panel of independent medical experts to make recommendations about which preventive services are worthy of widespread adoption. Those given the highest A rating include blood typing and antibody testing for pregnant women, blood pressure screening for adults and colorectal cancer screening.

The timetable would mean that insurance companies would probably not be required to cover the scans until 2015 at the earliest, but some are already on board with the change.

Anthem Blue Cross of California and Blue Shield of California, for example, say they have covered screening CT scans — subject to regular co-pay provisions — for high-risk smokers since 2011.

An Aetna spokeswoman said in an email that the company would cover the scans within 60 days of final approval. A Health Net spokeswoman said the company would comply as quickly as possible after a final decision, though some plans for 2014 have already been filed with regulators, so changing them might be difficult.

Sharp Chula Vista is offering a cash option, an out-of-pocket fee of about $300, for patients whose insurance does not cover screening.

While screening has been shown conclusively to increase a smoker’s chances of survival, Edelman, the American Lung Association doctor, noted that a 20 percent improvement in survivability still leaves 80 percent who die from lung cancer.

“The important thing is, let’s not say, ‘OK, we can stop all smoking cessation efforts.’ Stopping smoking is still the most effective way to stop lung cancer,” he said.