Ask the DOC

It is generally known that smoking cigarettes causes cancer, in particular lung cancer. Years ago, when cigarettes were unfiltered, most lung cancers occurred in the trachea and main bronchi, or the large diameter airways that carry air into and out of the lungs. This was because the particulate matter that was inhaled from unfiltered cigarettes was composed of relatively large particles that were too large to get to the smaller passages in the outer lungs. Cancers occurring in the large airways usually make their presence known early in the disease course by causing symptoms like severe cough and hemoptysis (coughing up blood). Symptoms that occur early in the disease make for an earlier diagnosis and treatment. With the advent of filtered cigarettes this changed, as the particles from these cigarettes are much smaller and can get to the smaller airways in the outer lung causing cancers without early symptoms. These cancers are diagnosed much later and often have already spread making treatment more problematic.

Recognizing this fact, last year the Centers for Medicare and Medicaid Services (CMS) disseminated a new policy for early detection of lung cancer in smokers and former smokers. The policy applies to people between 55 to 77 years old who are current smokers or have quit within 15 years, are asymptomatic, and have at least a 30 pack-year smoking history (one pack-year is equivalent to smoking one pack a day for one year). Those who qualify for this policy can get a prescription from their healthcare provider for a low-dose CT scan of the chest (LDCT). Low-dose refers to the amount of radiation the test uses. A chest X-ray has the equivalent amount of radiation that a person would receive from a day at the beach. In general, a CT scan has 50 times that amount of radiation, but a LDCT has significantly less. The policy calls for the LDCT to be repeated annually for as long as the patient is qualifies for it.

Medicare and Medicaid will automatically cover the LDCT without pre-authorization. Other healthcare plans require pre-authorization and may not cover the test, and that includes managed Medicaid and Medicare, especially Medicare “advantage” plans. The managed Medicaid and Medicare plans are not required to automatically cover the test and it has been my experience that they will deny coverage for it, despite the CMS recommendation and the obvious advantage to the patient of discovering early lung cancers. If you meet the criteria for a LDCT as outlined above, get to your healthcare provider to get the test authorized and done. Finally, if you still smoke, please stop. You know it’s not good for you.


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