BlueCross BlueShield of Tennessee Medical Policy Manual

Computed Tomography (CT) Scanning for Lung Cancer Screening

DESCRIPTION

Low-dose computed tomography (LDCT) is a radiographic technique that provides high-quality, three-dimensional images of the lungs with less radiation exposure than conventional high-resolution CT scanning.  This imaging technique has been proposed for screening asymptomatic, high-risk individuals for early lung cancer lesions.

LDCT uses either spiral (also referred to as helical) or electron beam (also referred to as ultrafast) CT scanning.  Compared with conventional CT scans, these scans allow for the continuous acquisition of images, thus shortening the scan time and radiation exposure. A complete spiral or ultrafast CT scan can be obtained within 10-20 seconds, or during one breath hold for the majority of individuals.  The radiation exposure for this exam is greater than that of a chest x-ray but much less than a conventional CT scan.

Annual screenings are recommended for individuals considered at high risk of lung cancer.  Risk factors include a long history of smoking and smoking cessation less than 15 years.  Screening should be discontinued once an individual has fifteen years of smoking cessation or develops a health problem that affects the individual’s ability or willingness to have curative lung surgery. 

This policy does not apply to individuals with signs and/or symptoms of lung disease.  In symptomatic individuals, a diagnostic work-up appropriate to the clinical presentation should be undertaken, rather than screening.

POLICY

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

ADDITIONAL INFORMATION 

According to the U.S. Preventive Services Task Force (USPSTF), “a ‘pack year’ means that someone has smoked an average of one pack of cigarettes per day for a year. For example, a person reaches 30 pack years of smoking history by smoking a pack a day for 30 years or two packs a day for 15 years.”

There is a lack of controlled scientific studies documenting the safety and efficacy of computed tomography for lung cancer screening for other indications.

SOURCES

American Association for Thoracic Surgery. (2012). The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. Retrieved March 21, 2017 from http://aats.org/aatsimis/AATS/Association/Guidelines/AATS/Association/Guidelines/Guidelines.aspx?hkey=6d9425da-43eb-4c79-bfb6-521cc52cb8c1.

American Cancer Society. (2013). American Cancer Society lung cancer screening guidelines. Retrieved March 20, 2017 from the National Guideline Clearinghouse (NGC: 009686).

American College of chest Physicians. (2013). Screening for lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Retrieved March 20, 2016 from the National Guideline Clearinghouse (NGC: 009872).

Centers for Medicare & Medicaid Services. CMS.gov. NCD for lung cancer screening with low dose computed tomography (LDCT). Retrieved March 20, 2017 from  https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=364&ncdver=1&DocID=210.14&from2=search.asp&bc=gAAAABAAAAAAAA%3d%3d&.

Chudgar, N., Bucciarelli, P., Jeffries, E., Rizk, N., Park, B., Adusumilli, P., et al. (2015, May) Results of the National Lung Cancer Screening Trial: Where Are We Now? Thoracic Surgery Clinics, 25 (2), 145–153. (Level 2 evidence)

Kovalchik, S. A., Tammemagi, M., Berg, C. D., Caporaso, N. E., Riley, T. L., Korch, M., et al. (2013). Targeting of low-dose CT screening according to the risk of lung-cancer death. New England Journal of Medicine, 369 (3), 245-254. (Level 4 evidence)

National Cancer Institute. (2016, November). Lung cancer screening (PDQ®). Retrieved March 20, 2017 from http://www.cancer.gov/cancertopics/pdq/screening/lung/HealthProfessional.

National Comprehensive Cancer Network. (2016). NCCN clinical practice guidelines in oncology. (NCCN Guidelines®). Lung cancer screening (V.1.2017). Retrieved March 20, 2017 from http://www.nccn.org

National Lung Screening Trial Research Team, Aberle, D. R., Adam, A. M., Berg, C. D., Black, W. C., Clapp, J. D., et al. (2011). Reduced lung-cancer mortality with low-dose computed tomographic screening. New England Journal of Medicine, 365 (5), 395-409.

U. S. Food and Drug Administration (2003, November) Center for Devices and Radiologic Health. 510(k) Pre-Market Notification Database K033374. Retrieved May 20, 2016 from: http://www.accessdata.fda.gov.

U.S. Preventive Services Task Force. (March, 2014). Screening for lung cancer: U. S. Preventive Services Task Force recommendation statement. Retrieved June 9, 2015 from www.USPreventiveServicesTaskForce.org.

Winifred S. Hayes, Inc. Medical Technology Directory. (2013, April; last update search March 2016). Low-dose helical (spiral) computed tomography for lung cancer screening. Retrieved May 20, 2016 from www.Hayesinc.com/subscribers. (71 articles and/or guidelines reviewed)

ORIGINAL EFFECTIVE DATE:  10/1/2003     

MOST RECENT REVIEW DATE:  6/8/2017

ID_BT

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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