EagleTribune.com, North Andover, MA

August 5, 2013

Doctors: Cancer scans a vital tool

Group recommends screenings, insurance coverage for smokers

By Brian Messenger

---- — Annual lung cancer screenings for heavy smokers may soon be covered by health insurers, dramatically boosting the chances for early detection of what is the deadliest form of the disease.

More than 8,000 Massachusetts residents die each year from the effects of smoking. Nationwide, smoking-related deaths total 160,000 annually and tobacco use is considered the leading cause of preventable death and illness.

Local doctors report that most lung cancer patients aren’t diagnosed until the advanced stages of the disease have taken hold. As a result, chances of survival are considerably slimmer than with other types of cancer.

But that all could change if an independent group of government advisers finalizes its first-ever recommendation for annual lung cancer screenings among those deemed at greatest risk. Experts say the change would clear the way for insurers to cover CT scans, a type of X-ray, for current and former heavy smokers ages 55 to 79.

“Early detection is the key,” said Dr. Han-Ting Lin, medical director of oncology and hematology at Holy Family Hospital in Methuen. “It’s a no-brainer. We want to detect lung cancer at a very early stage.”

A heavy smoker is considered an individual who smoked a pack of cigarettes a day for 30 years or the equivalent, such as two packs a day for 15 years. Not included in the group is people who quit at least 15 years ago, or people too sick or frail to undergo cancer treatment.

If the recommendation by the U.S. Preventive Services Task Force is finalized, which is expected, some medical experts estimate the change will cut down the annual number of smoking-related deaths in the country by about 20,000.

“I truly believe it can save lives,” said Gabriele Southgate, a senior staff physician with Lahey Clinic who works at the Parkland Medical Center campus in Salem, N.H. “That is huge progress, and more progress is needed.”

Tests would become ‘routine’

Southgate said a trade-off with increased lung cancer screenings is that the practice will come at a cost to the health care system. That’s why she believes strong anti-smoking education efforts must continue.

“It’s a very important message,” she said. “We know that 90 percent of all lung cancers are related to tobacco use.”

Smoking costs the Massachusetts economy more than $5.5 billion each year, according to the website of the Massachusetts Tobacco Cessation & Prevention Program, which is associated with the state Department of Public Health. A DPH spokeswoman declined comment for this story. A request for comment from DPH Commissioner Cheryl Bartlett also went unanswered last week.

One way to curb smoking may be sticker shock.

The cost of a pack of cigarettes rose to more than $10 in some parts of Massachusetts last week, after a $1 tax increase took effect, bringing the total state tax on cigarettes to $3.51 per pack — the second highest in the nation.

“Most smokers don’t want to smoke,” said Diane Knight, director of the North Essex Tobacco Free Community Partnership based in Lawrence. “When the price goes up on tobacco products, the use goes down.”

Knight estimated that last week’s cigarette tax hike will prevent 27,000 young people from enduring “a lifetime of addiction to tobacco” while also helping to motivate another 25,000 adults to quit smoking.

As for the prospect of annual lung cancer screenings for heavy smokers, Knight said she was “intrigued” by the possibility.

If the recommendation is finalized, some area medical professionals believe that over time regular lung screenings for heavy smokers will seem as commonplace as a doctor recommending a mammogram or colonoscopy.

“Definitely, primary care doctors can have a big impact on their patients,” said Dr. Lin of Holy Family Hospital. “It will be more like a routine.”

‘It’s a big taboo’

Area doctors say the current cost of a CT scan depends on where it’s performed. While some clinics bolstered by grants can provide patients with free or inexpensive lung scans, other hospitals must charge several hundred dollars.

“Because none of the insurance companies are covering it, none of the primary care physicians are requesting it,” said Dr. Shalini Reddy, a thoracic surgeon at Lawrence General Hospital. “Obviously, payment is a big issue — $300 is not cheap.”

Both Reddy and Lin said a stigma remains regarding smoking-related illness and health care coverage. Lin described one line of thinking like this: “These people did this to themselves. Why should society pay for the CT scan?”

“I think it’s a big taboo,” Reddy said. “You are causing it yourself.”

But the doctors said many longtime smokers began their habit without full knowledge of tobacco’s harmful effects. Ultimately, they said much of the stigma surrounding smoking-related disease appears to be fading.

“It’s important for people to realize that these CT scans will be very beneficial,” Reddy said. “I hope (the recommendation) goes through.”

Reddy said what makes lung cancer the “most notorious killer” is that it’s often not detected early enough.

While only 15 percent of patients survive after being diagnosed with advanced-stage lung cancer, Reddy said the survival rate for the lower stage-one lung cancer is 75 percent. A change toward regular and affordable CT scans will save lives, she said.

“What lung cancer patients are missing now is early detection,” Reddy said. “A lot of our patients will benefit.”

Material from the Associated Press was used in this report.