Decision By Medicare's CMS To Deny Coverage For 'Virtual' Colon Cancer Tests Underscores Lack Of Evidence On Cancer Prevention

Main Category: Colorectal Cancer
Also Included In: MRI / PET / Ultrasound;  Medicare / Medicaid / SCHIP;  GastroIntestinal / Gastroenterology
Article Date: 14 May 2009 - 1:00 PDT

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The decision by the Centers for Medicare & Medicaid Services to deny payment for CT colonography, also known as "virtual" colonoscopy, a radiographic examination of the abdomen, underscores the lack of sufficient evidence on the test's potential as an appropriate option for the screening and prevention of colorectal cancer.

"One of the primary issues identified by CMS is that patients who have polyps identified by CT scan of the abdomen will still have to undergo complete colonoscopy," explained Eamonn Quigley, M.D., FACG, President of the American College of Gastroenterology. The American College of Gastroenterology and the Multi-Society Task Force Guideline on Colorectal Cancer in recent guidelines have stated clear preferences for tests which prevent colorectal cancer.

The American College of Gastroenterology has long supported the lifesaving potential of screening by colonoscopy specifically because it is widely available, safe and effective. "There is no evidence that any radiographic test, including CT colonography, prevents the development of colorectal cancer. Colonoscopy is one of the most powerful preventive tools in clinical medicine because of its excellent sensitivity in detecting polyps and its potential for removing them and breaking the sequence of polyp to cancer in a single diagnostic and therapeutic intervention," said Dr. Quigley.

Physician experts from the American College of Gastroenterology believe consumers should recognize that CT colonography does not currently represent a painless or risk-free procedure, nor does it eliminate the need for bowel cleansing which many patients report as a barrier to screening. There is also evidence that due to the insertion of a tube in the rectum and insufflation of the abdomen with air or gas, the patients, who are not sedated and awake, tend to feel discomfort.

The College recognizes that CT colonography might be an option to consider for patients who, because of infirmity or the presence of significant co-morbid diseases, would be at an increased risk for complications in relation to colonoscopy. However, the vast majority of patients would benefit from the potentially lifesaving benefits of screening for colon cancer using colonoscopy.

When evaluating new potential screening technologies, including CT colonography, the ACG has focused its evaluation on several pieces of evidence including: sensitivity for identification of polyps of various sizes, standards for polyp removal, balancing patient risks (in this case from radiation exposure) with benefits, frequency of exams and the economic impact to the healthcare system of separate diagnostic and therapeutic exams.

"There is a tremendous body of evidence that shows that clearing the colon of polyps, including small polyps, significantly reduces colorectal cancer mortality. Because of its excellent sensitivity in detecting polyps and its potential for removing them and breaking the sequence of polyp to cancer in a single diagnostic and therapeutic intervention, complete colonoscopy is one of the most powerful preventive tools in clinical medicine. Until a radiographic test can meet that standard, gastroenterologists will continue to champion the lifesaving potential of colonoscopy," added Dr. Quigley.

Source: American College of Gastroenterology