USPTF approves CT lung screening

[Taurus]

9 million smokers should get yearly lung screening, task force says

Heavy smokers who are at least 55 should have an annual CT scan to check for lung cancer, a government panel says. The recommendation, which could apply to about nine million Americans, would mean Medicare and many health insurance companies must start providing the test for free to patients.

The screening test, which costs $250-$300, may prevent as many as 20 percent of future deaths from lung cancer, the U.S. Preventive Services Task Force (USPSTF) says in its recommendations, published in the Annals of Internal Medicine. Other experts note that in real-world practice, the actual numbers may be much lower.

...

It’s a draft recommendation – open for comment – and it’s graded “B” by the USPSTF. That means Medicare, the federal health insurance plan for the elderly, would pay for the screening for eligible patients. And the 2010 Affordable Care Act, known commonly as Obamacare, requires health insurers taking part in the new insurance marketplaces to provide, free of charge, all screening services rated A or B by the USPSTF.

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[DrBowtie]

Curious if Chest fellowships will suddenly boom in popularity due to expected increase in volume.

 

[Taurus]

Curious if Chest fellowships will suddenly boom in popularity due to expected increase in volume.

I doubt it. I don't think you need to do a chest fellowship to spot subcentimeter nodules and follow Fleishner guidelines.

With 9 million new annual scans, you need someone to read them all and only radiologists can fill those positiions. This will create a lot of new jobs for radiologists.

I expect virtual colonoscopy to pass in a few years too. This also will drive up demand.

The great thing about radiology is that it's technology driven and there's always new ones (molecular imaging, etc) tomorrow. I didn't say anything about salaries because that's out of our hands, but at least you'll have a job.

 

[cowme]

I already couldnt imagine anything more boring than a chest fellowship.

Now throw in an extra 10 nodule hunting cases a day in patient with horrible underlying lung disease? Yikes. No thank you

 

[fun8stuff]

I already couldnt imagine anything more boring than a chest fellowship.

Now throw in an extra 10 nodule hunting cases a day in patient with horrible underlying lung disease? Yikes. No thank you

Once CAD improves, nodule follow-ups will be much more tolerable.

 

[cowme]

CAD has shown itself to be near useless in its decade of existence, and has shown no signs of improvement thus far

 

[yoyoniner]

That's actually very, very good news for radiology. What's amazing is the UPTF gave it their B recommendation which, under Obamacare, means that Medicare and insurance companies must provide this screening free just like mammography.

 

[yoyoniner]

Wow I missed the fact too that this new recommendation is for ANNUAL screening.

Talk about a big potential increase in radiology volume!

 

[Doctor D]

There are about 25,000 radiologists on the US so if all 9 million heavy smokers were screened annually this would equal about 1 extra CT scan a day per radiologist. Not a boom for radiology but a step in the right direction.

 

[Taurus]

There are about 25,000 radiologists on the US so if all 9 million heavy smokers were screened annually this would equal about 1 extra CT scan a day per radiologist. Not a boom for radiology but a step in the right direction.

Wrong way to think about it. Most radiologists, especially in academics, eventually settle on certain areas that they will and won't read or do. For example, most radiologists won't read mammo, nucs, do IR, MSK MRI, etc. Only a subset of those 25k radiologists will want to do CT lung screening, virtual colonoscopy, overnight cardiac CTA, etc. 9 million new scans per year to read is a lot of new work no doubt about it.

 

[DrBowtie]

Wrong way to think about it. Most radiologists, especially in academics, eventually settle on certain areas that they will and won't read or do. For example, most radiologists won't read mammo, nucs, do IR, MSK MRI, etc. Only a subset of those 25k radiologists will want to do CT lung screening, virtual colonoscopy, overnight cardiac CTA, etc. 9 million new scans per year to read is a lot of new work no doubt about it.

Not to mention the downstream effects such as biopsies, upper abdominal findings requiring further work up.

 

[Taurus]

Not to mention the downstream effects such as biopsies, upper abdominal findings requiring further work up.

Good points and very true. This approval is huge. With these new technologies coming down the pipeline, I wonder if there's going to be enough radiologists to do all this work. You'll be hearing about a shortage of radiologists in the not too distant future. Everyone knows what happens to salaries and jobs when supply can't keep up with demand.

 

[shark2000]

Agree with DrBowtie and Taurus. They hit it on the head.

As DrBowtie said if the CT is positive, then further procedures will follow including PET-CT, Biopsy, post surgery follow ups and .... Also don't forget that this is low dose screening test that should be confirmed by a diagnostic CT.

One extra CT a day per radiologist is a lot. It is the average and as Taurus said it will result in a lot more per radiologist. If you follow the same logic, many things that many doctors are doing has a share of less than 0.1 per doctor per day. Why do they even bother themselves doing it?

I think radiology as a community should become actively involved in this program. We have to offer a comprehensive clinic of screening similar to mammo. I personally hate mammo but their practice model can be a good model for lung cancer screening. We have to provide screening, patient consult, biopsy service, post biopsy observation, biopsy follow up and referral to CT surgery and oncology if a cancer is diagnosed. Also follow up on patients with nodules, similar to what we do for mammo is very importatnt. This can be achieved by a close cooperation between chest radiology department and IR.

I personally think this will result in more job opening for chest fellowship trained people with light interventional skills (biopsy, chest tube, ...) esp in academics.

 

[tco]

I haven't been able to find a definitive answer to how much radiation one is exposed to with the screening CT. I was under the impression that it's barely above a CXR. Is this accurate?

 

[fun8stuff]

CAD has shown itself to be near useless in its decade of existence, and has shown no signs of improvement thus far

Yes and "640K ought to be enough for anybody." Its foolish to think that these technologies will not improve.

 

[Lacuna]

I haven't been able to find a definitive answer to how much radiation one is exposed to with the screening CT. I was under the impression that it's barely above a CXR. Is this accurate?

tco,

The chest CTs used for screening are low dose, on average 2 mSv compared to 7 mSv for a standard chest CT. 2 mSV is equivalent to ~8 months of background radiation. Chest x-rays are a magnitude lower dose, about 0.02 - 0.1 mSv.

http://www.ncbi.nlm.nih.gov/pubmed/22021510

 

[cowme]

smoking a pack of cigarettes a day is worth ~10 msv in one year, for perspective

 

[Med0123]

Will this screening tool be offered to smokers or only to ex-smokers who stopped X months ago?

 

[yoyoniner]

Will this screening tool be offered to smokers or only to ex-smokers who stopped X months ago?

I hate to sound like an ass but all you have to do is read the article.

 

[g8orlife]

EDIT: NVM. Found the article(s):
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204895/

http://www.nejm.org/doi/full/10.1056/NEJMoa1102873

 

[yoyoniner]

EDIT: NVM. Found the article(s):
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204895/

http://www.nejm.org/doi/full/10.1056/NEJMoa1102873

A link to the article is also on the original post (first line).

 

[g8orlife]

A link to the article is also on the original post (first line).

The original post (first line) is the recommendation article. I posted two research articles from 2011 that lead to that recommendation article.