The Free Press, Mankato, MN

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January 1, 2014

Our View: New cancer screening raises issues

Why it matters: A new recommended lung cancer screening for smokers raises health care cost and efficacy issues

Anyone who has experienced the devastation of lung cancer on a friend or family member would likely welcome a new recommendation for a new lung cancer screening that would detect the disease earlier and allow treatment.

Lung cancer is one of the most devastating cancers in terms of its toll on the body of the afflicted. It is also one of the most difficult cancers to detect early enough so treatment is effective. Victims of lung cancer typically must simply live out their remaining days without any hope for treatment, many times in pain.

But a new recommendation from the U.S. Preventive Services Task Force raises many difficult questions about how much more spending the health care system can take and whether we open the floodgates for “cancer-screening cowboys” looking for an entrepreneurial opportunity.

The influential task force recommended a new lung cancer screening for long-time heavy smokers. It recommended CT scans of the lungs for those at highest risk of developing lung cancer – those who smoked a pack of cigarettes a day for 30 years or the equivalent such as two-packs for 15 years.

The task force recommends that the screening be for such people who are between the ages of 55 and 80.

We clearly want as much prevention as we can get in our health system. The task force estimates some 20,000 of the 160,000 death from lung cancer annually in the U.S. could be prevented.

Even as the recommendation came out, the task force was suggesting caveats, like those who wouldn’t be able to endure cancer treatment shouldn’t be selected for screening. But after our politicization in the last few years of so called “death panels” the task force’s recommendation raises lots of questions.

We also know that the last weeks of a sick person’s life are the most costly to the health care system. It’s not yet clear if the screenings would in the long run be less costly than all the treatment that would be necessary at the end of life for the thousands more who detect cancer earlier and get treatment. Some will still die.

Under the Affordable Care Act the task forces preventive recommendations could be eligible for coverage with no deductible. Again, this raises questions of cost versus benefit.

At some point, we have to put the emphasis less on costly treatments for unhealthy behavior to simply emphasizing and incentivizing healthy behavior.

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