In November Medicare published its intention to cover the cost of annual lung cancer screening for people with a history of heavy smoking.

Widespread screening is expected to save tens of thousands of lives each year.William Burfeind, MD, chief of thoracic surgery, St. Luke's University Health Network, recently shared with the Times News about the decision and why heavy smokers should be screened.Burfeind is also a clinical associate professor of surgery at Temple University.Q. Why is this significant?A: The National Cancer Institute estimates that in 2013 alone, 220,000 new cases of lung cancer were diagnosed and 160,000 people died of lung cancer. Lung cancer is a leading cause of death in the United States, second only to heart disease.It causes more deaths than any other type of cancer. In fact, more Americans die each year from lung cancer than colon, breast, prostate and lymphoma cancer added together.The Medicare decision is critical because the median age of diagnosis of lung cancer is 70 years in the United States. Medicare coverage will increase the number of smokers screened, which in turn will result in more cancers being found in the early stages of the disease, when it is most treatable.Q: How can we reduce the number of deaths from lung cancer?A: We can reduce lung cancer deaths two ways, first by preventing the disease from ever developing. The best way to prevent lung cancer is to refrain from smoking. If you haven't started smoking, don't. If you already smoke do whatever you can to quit as soon as possible.The second way is by discovering tumors early in the progression of the disease. Finding cancer at the earliest possible stage is the premise of all cancer screening tests. Currently, the majority of cancer diagnoses are made when the disease has spread to another part of the body.Q: Why is lung cancer so deadly?A: Lung cancer has few, if any, recognizable symptoms when it first develops. The progression of the disease is classified by stages, which identify the extent and severity of the disease, guide treatment and predict the patient's likely outcome or prognosis. Stages range from I to IV, and the earlier the stage in which the cancer is found, the more curable it is.In stage I, the cancer is small and confined within the lung. By stage II it has spread to a lymph node nearby, and by stage III has spread to the lymph nodes in the middle of the chest. In the most advanced stage, stage IV, the cancer has advanced to both lungs, the fluid in the area around the lungs or to another part of the body, such as the brain, bones or other organs.Q: When are the majority of cancers usually found?A: Currently, 60 percent of lung cancer diagnoses are made when the cancer has already progressed to stage IV. If we could flip that statistic, and identify 60 percent of lung cancer in its early stages, stage I or II, then we would have a real shot at reducing mortality from this disease.Q: Some people are diagnosed with early stage lung cancer. How does that occur?A: Usually, it is a matter of chance. A patient has a chest X-ray because they have pneumonia or as part of a presurgical workup, such as before knee replacement surgery. Then, the radiologist reads the scan and identifies the tumor.Q: Has the effectiveness of screening to identify early cancers ever been tested?A: Yes. The National Institutes of Health tested this hypothesis with the National Lung Screening Trial. This large trial screened 53,000 people at high-risk with low-dose CT scans or regular chest X-rays. The study found that the group that was screened with CT scans had a 20 percent reduction in death from lung cancer.In this trial, a lung cancer death was averted for every 320 people screened and, as hoped, 65 percent of the cancers found were either stage I or II. Of these early stage cancers found, nearly half were at the earliest stage, IA.The National Lung Screening Trial results were published in 2011, and lung cancer screening was quickly endorsed by most professional societies whose physicians take care of lung cancer patients. However, since no insurance companies covered the cost of lung cancer screening, very few eligible patients were screened.Q: Did St. Luke's offer screening?A: Yes. Shortly after the results were published, St. Luke's began providing lung cancer screening for present or past heavy smokers between 55 and 74. To make it affordable, people are charged $49 and St. Luke's absorbs the difference between the fee and the cost of the test. The investment has been worthwhile.Q: What have been the results of the screening at St. Luke's?A: Our success in finding early stage tumors has been even greater than the results of the National Lung Screening Trial. We have screened well over 1,000 people and have found lung cancer in one out of every 100 people. Of those, 50 percent were stage I.Q: How are they now?A: The early stage patients underwent minimally invasive resections and are currently cancer-free today as a result.Q: Do private insurers cover screening?A: Not yet, but they will be required to do so in 2015. Let me provide you with some background. In December 2013, the U.S. Preventive Services Task Force endorsed screening people at high-risk for lung cancer with yearly low-dose CT scans. The task force is the government body responsible for evaluating cancer screening tests and has traditionally been very cautious in its recommendations. (You may recall its controversial recommendations related to breast cancer screening.)Its endorsement of lung cancer screening meant that private insurers would ultimately be required to cover lung cancer screening under the Affordable Care Act (scheduled to go into effect in January 2015.)Q: Did the Affordable Care Act require Medicare to cover screening?A: No, it was not until last month that Medicare finally published its intention to cover lung cancer screening.Q: Does Medicare cover screening for all recipients?A: No. Screening has risks and therefore should be limited to those most likely to develop the disease. To be screened, people must have a physician's order and meet the following eligibility requirements:• Be between age 55 and 74 and have no symptoms of lung cancer• Are currently smoking or have quit within the past 15 years• Have smoked at least 30 pack-years. A pack-year is calculated by multiplying the number of packs smoked per day, times the number of years smoked; so 30 pack-years is smoking one pack per day for 30 years or 2 packs per day for 15 years.Q: Is there any downside to lung cancer screening?A: Cancer screening is not free. Costs can be calculated both in monetary terms and unintended harms associated with cancer screening. During the National Lung Screening Trial, approximately 30 percent of people being screened had a lung nodule a small CT scan abnormality that needed follow-up. Almost all of those turned out to be noncancerous. Unfortunately, many people experienced anxiety and a few underwent invasive biopsies for what turned out to be benign nodules.Q: How do I know if I should get screened?A: The U.S. Preventive Services Task Force has recommended yearly screening of all people who meet the above criteria. You should weigh the risk of unintended harm against the benefits. Your primary care physician can help you with this decision. By not being screened, you could now, or in the future, have lung cancer and not even know it. Should cancer develop, you would have a very slim chance of identifying it early, when it is most curable.As a thoracic surgeon, I follow many patients who are alive today because they were "lucky enough" to have pneumonia or some other health problem, and consequently the lung cancer was found inadvertently. I wholeheartedly support annual screening for heavy smokers and applaud Medicare for its intention to cover the cost.