May 31, 2014
The U. S. Preventive Services Task Force, made up of 16 medical experts appointed by the federal government's Department of Health and Human Services, has recently recommended that former and current smokers, ages 55 to 80, receive annual CT scans to test for lung cancer. If the recommendation is put into effect, insurers, as a result of Obamacare, would be required to cover the procedure for around 10 million Americans who would qualify. To be sure, the requirement, as compared with chest rays and illustrated by a study by the National Cancer Institute, could result in a 20 percent decrease in deaths from smoking.
Unfortunately, however, the panel overlooked a critical group among Americans aged 55 to 80: namely, nonsmokers who are increasingly diagnosed with the disease. About 15 percent of the more than 200,000 annual cases of lung cancer, which kills more victims than all other cancers combined, are nonsmokers. And two-thirds of these are women.
My late wife was a typical example. A nonsmoker and nondrinker, she was diagnosed with the disease in late 2010 at age 70. She had no outward symptoms (or hereditary or environmental legacies), save for what appeared to be lingering sinus infections, and because she had always been in excellent health, the attempt to hone in on her discomfort was conservative and cautious. A chest X-ray revealed nothing suspicious, and not until a CT scan was employed was stage-four lung cancer diagnosed. Her oncologist estimated that when diagnosed she had had the disease for at least a year, more likely two.
Among 10 of my closest friends, three older women who never smoked, living in three different areas of the nation (Florida, New York and Maryland), have been diagnosed with stage-four lung cancer.
No doubt, the Preventive Services Task Force was moved to its conclusion by the greater number of deaths from smoking. But recall that this year marks the 50th year anniversary of the 1964 U.S. surgeon general's report that linked smoking to lung cancer. And long before that landmark report, Americans were aware of the harmful effects of cigarettes, with the term "coffin nail" coined in the 1880s and well-publicized scientific studies emerging in the early 20th century.
The point is obvious: Smokers have long been forewarned, and although they should not be neglected in terms of treatment for lifestyles they chose, doesn't it stand to reason that all age-suspect, especially non-risk taking, Americans, should be accorded more medical attention? For decades, women were ignored by the medical community in terms of cardiovascular disease, leading to heart disease as their number one killer. Now, their predisposition to nonsmokers' lung cancer is being treated as another medical anomaly.
Of course, CT scans are more expensive than chest X-rays, but even a cursory view of the facilities that provide them would suggest that they don't benefit from economies of scale. In other words, they are not used to their maximum count per day, with idle hours apparent to patients who, like my wife, routinely used the high-tech radiology. With more usage, CT scans should become more affordable to insurers, especially Medicare, which has the insurance clout to overhaul the procedure's cost. That's what has happened to mammography, which is universally covered in terms of the detection of breast cancer.
Indeed, Medicare may well be the perfect conduit for effecting payment for annual CT scans for senior citizens as a result of the annual "wellness" visit introduced this year. Designed "to develop or update a personalized plan to prevent disease or disability based on your current health and risk factors," the visit is meant "to help you stay healthy."
And one final point: It requires no out-of-pocket costs.
Thomas V. DiBacco is professor emeritus at American University in Washington, D. C. His email is Tvmzdb6063@cs.com.
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