July 10, 2023
By Bryte Johnson
Government Relations Director, American Cancer Society Cancer Action Network
The Connecticut General Assembly wrapped up its 2023 session late on June 7. The state Budget provided $453,000 in funding to create a new Lung Cancer Early Detection and Treatment Referral Program to be administered through the state Department of Public Health, thereby providing greater awareness, access, and equity to an underutilized preventative tool. The intent of the program is to (1) promote screening, detection, and treatment to people ages 50 to 80, prioritizing high-risk populations and (2) provide public education, counseling, and treatment referrals.
Currently, as with breast and cervical screenings, lung cancer screenings are covered by Medicare and because lung screenings are recommended by the US Preventive Services Task Force (USPSTF), private insurers have also begun covering the tests. However, also like people that qualify for BCCEDP, there are individuals that fall through the coverage cracks and this new program could be the only option available to them.
In Connecticut, lung cancer is the third most common cancer, however more than twice as many die from lung cancer as from any other cancer[i].
An NCI National Lung Cancer Screening Trial (NLST) studied over 53,000 current and former smokers and compared chest x-rays with low dose CT scans as means of screening for lung cancer amongst high-risk individuals. Those with low dose CT screening had a 20% lower risk of dying, and approximately 75% had early-stage lung cancer, while those in the chest x-ray or unscreened populations had approximately 75% advanced stage III and IV cancers.
Accordingly, in 2013, The US Preventative Services Task Force developed standards and made recommendations for annual screenings for lung cancer, which did result in insurance coverage by most commercial insurances, Medicaid, and Medicare. However, like with those that qualify for BCCEDP, some still fall through the coverage cracks.
More alarmingly, despite coverage being available, lung cancer screenings are not widely employed for a number of reasons—with only about a 6% utilization rate in CT.
Lung cancer screening is recommended for certain people who smoke or used to smoke, but who don’t have any signs or symptoms. If a person has lung cancer but doesn’t have any symptoms, this usually means there’s a chance to detect the disease early. If lung cancer is found at an earlier stage, when it is small and before it has spread, it is more likely to be treated successfully.
The American Cancer Society advises that health care providers, and people at increased risk for lung cancer, follow the recently updated recommendations for annual lung cancer screening from the US Preventive Services Task Force (USPSTF), the American Academy of Family Physicians (AAFP), or the American College of Chest Physicians.
These organizations recommend yearly lung cancer screening with LDCT scans for people who:
- Are 50 to 80 years old and in fairly good health, and
- Currently smoke or have quit in the past 15 years, and
- Have at least a 20 pack-year smoking history. (This is the number of packs of cigarettes per day multiplied by the number of years smoked. For example, someone who smoked 2 packs a day for 10 years [2 x 10 = 20] has 20 pack-years of smoking, as does a person who smoked 1 pack a day for 20 years [1 x 20 = 20].)
In addition, it’s important that people who are going to be screened:
- Receive counseling to quit smoking if they currently smoke, and
- Have been told by their doctor about the possible benefits, limits, and harms of screening with LDCT scans, and
- Can go to a center that has experience in lung cancer screening and treatment.
To get the most benefit from screening, people need to be in fairly good health. For example, they need to be able to have surgery and other treatments to try to cure lung cancer if it is found. People who have other major health issues that could keep them from having lung surgery might not be good candidates for lung cancer screening. The same is true for people who might have a shortened life expectancy because they already have other serious medical conditions.
Screening should only be done at facilities that have the right type of CT scanner and that have experience in LDCT scans for lung cancer screening. The facility should also have a team of specialists that can give patients the appropriate care and follow-up if there are abnormal results on the scans.
Implementation and roll-out of the new LCEDTRP is expected to occur over the next several months and we will be reviewing and weighing in on any establishing regulations DPH may create as well as monitoring future appropriations to ensure the viability and success of the Program.