The hopes of imaging equipment and software makers, the American Cancer Society and radiologists were dashed with CMS' final decision not to cover computed tomography colonography for colorectal cancer screening. Find out more...
The hopes of imaging equipment and software makers, the American Cancer Society and radiologists were dashed with CMS' final decision not to cover computed tomography colonography for colorectal cancer screening.
The agency's May 12 decision memo calls CT colonography "a promising technology," but says there is not enough evidence to conclude that the procedure improves health outcomes for people aged 65 and older.
A coalition of imaging equipment manufacturers, physicians and patient advocates demanded that CMS immediately re-open the rulemaking process to consider "any new data and evidence that emerges" regarding the over-65 Medicare population.
The American College of Radiology, meanwhile, called on Congress to step in and make coverage for the screening procedure mandatory. Legislation proposing to do so is a distinct possibility given the outspoken support for the screening option among more than 50 House members who urged CMS to provide coverage earlier this year (1"The Gray Sheet" March 16, 2009, p. 20).
The American College of Radiology and several other professional societies argued in comments to CMS that coverage of CT colonography, a minimally invasive procedure that takes just 10 minutes, would result in more Medicare beneficiaries getting screened for colorectal cancer (CRC).
Their reasoning was that many people avoid getting screened because they find the prospect of traditional colonoscopy, which involves anesthesia and the insertion of a colonoscope into the rectum and colon, unpleasant and frightening.
But CMS notes in its final decision memorandum that "there is no published study that has shown an increase in overall CRC screening from adding CT colonography compared to an appropriate control."
The agency encourages clinical research specifically assessing the impact of CT colonography on overall colorectal cancer screening rates. CMS says that higher screening rates would be an important finding, but that at present, "it is unknown if CT colonography will or will not increase screening."
Many commenters supportive of coverage also pointed to a recent study of 2,600 patients that found that CT colonography identifies 90% of patients with adenomas or cancers 10 mm or larger. The study, led by C. Daniel Johnson, Mayo Clinic Arizona, was published last September in the New England Journal of Medicine.
CMS reviewed this study in making its coverage decision, but felt that the findings, which involved patients as young as 50 years old, could not be generalized to Medicare-aged individuals.
Applauding the non-coverage decision was the American College of Gastroenterology, representing physicians who perform colonoscopies. The group noted that CT colonography is in fact not "painless or risk-free," and does not eliminate the need for the bowel cleansing that many patients report as a barrier to screening.
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