Lung cancer screening.

Although we agree with a statement by Detterbeck et al 1 in the American College of Chest Physicians (ACCP) lung cancer screening guideline in a recent issue of CHEST (May 2013) that, “The cost of the process of [CT lung] screening should be reimbursed fairly,” the authors’ assertion that “establishing a discounted rate as a strategy to capture patients...creates a structure that can increase harms from excessive investigation of benign nodules” is speculation without suffi cient support to be included in an evidence-based guideline statement. Screening high-risk individuals with low-dose chest CT (LDCT) scans saves lives and is endorsed by nine national medical societies, including the American Cancer Society, with the largest impact on cancer deaths resulting from a single intervention in several decades. 1 3 Self-pay presents a signifi cant economic barrier for qualifi ed patients. Free screening is an interim measure to provide equitable access. McKee et al’s 4 recent article in the Journal of the American College of Radiology describes an ongoing National Comprehensive Cancer Network Guidelines-based free LDCT scan lung screening program demonstrating initial results similar to those reported in the National Lung Screen ing Trial. 5 Free LDCT scan lung screening achieves the goals of the Affordable Care Act .