ATS Develops Decision Aid for Lung Cancer Screening with CT

In February, the Centers for Medicare & Medicaid Services issued its final coverage policy for CT lung cancer screening under Medicare, allowing coverage of annual low-dose CT lung cancer scans for beneficiaries who meet specific criteria.

Renda Wiener, MD, MPH

Renda Wiener

“This is the first time that Medicare has required a decision aid and the use of shared decision-making for reimbursement of a screening test,” says Renda Wiener, MD, MPH, who as a member of the ATS Thoracic Oncology Assembly developed and reviewed the Decision Aid with Christopher Slatore, MD, MS, chair; Doug Arenberg, MD; and Marianna Sockrider, MD, DrPh, ATS medical editor for patient education.

Dr. Wiener attributes the impetus for the CMS policy requiring use of a decision aid to evidence about the benefits and harms of screening. The National Lung Screening Trial showed a 20 percent reduction in lung cancer mortality with annual CT screening, but the trial also showed a high false-positive rate—pulmonary nodules requiring further evaluation were detected in about 40 percent of patients.

Physicians can use this tool, which is available at and will be on hand at the Assembly of Thoracic Oncology meeting from 5 to 7 p.m. tonight at the Hyatt Regency Denver, to help patients systematically go through the pros and cons of lung cancer screening.

“We designed the Decision Aid with language and visuals that are easy for patients to understand. It’s a useful tool to help guide the discussion about the tradeoffs of lung cancer screening and to achieve the shared decision-making that is necessary for Medicare reimbursement,” says Dr. Wiener, assistant professor of medicine at Boston University and an investigator at Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA.

The Decision Aid describes all of the considerations for lung cancer screening, including the resources for smoking cessation, benefits of screening, symptoms of lung cancer, risk factors for lung cancer, research about the benefits of screening, harms of screening, physician interventions to prevent screen harms, and screening process.

“Although 95 percent of nodules detected through screening turn out to be false-positive results, the evaluation process can expose patients to harm,” Dr. Wiener says. “That includes anxiety and distress about undergoing radiographic surveillance and not knowing whether they have cancer, physical complications for those needing a biopsy, and, in the worst-case scenario, the possibility of unnecessary surgery to remove a nodule that is thought to be malignant and turns out to be benign. Surgery, of course, has the potential for complications, including death.”

The high false-positive rate could be attributed to variability in CT scan readings.

“There is a large effort to standardize the way that CT scans are read using a structured reporting system, such as Lung-RADS that has been proposed by the American College of Radiology,” Dr. Wiener says.