Diagnostics & Imaging Week Washington Editor

The Centers for Medicare & Medicaid Services has proposed not to cover screening for colorectal cancer (CRC) with computerized tomography (CT) to the disappointment of many. The agency took up the matter May 19, 2008, and posted the memo on its web site on Tuesday, eight days early.

CMS's proposed decision memo states that the repeated exposure to X-radiation is a concern, as was also expressed by a number of those who commented during the open comment period. Another of the impediments to coverage is that "the mean age of participants in [the supporting studies] ... was considerably younger than the Medicare aged population," thus calling generalizeability of the study data into question. CMS also noted that CT colongraphy does not effectively pick up polyps smaller than 6mm in length, and that because surgeons typically remove polyps of all sizes during optical examinations, little is known about the natural history of colon polyps.

Durado Brooks, MD, chief of the division of prostate and colon cancer at the American Cancer Society (ACS; Washington) told Diagnostics & Imaging Week that ACS is "disappointed that CMS will not cover CT colonography for the Medicare population," but acknowledged that there is a gap in the understanding of how polyps evolve. He said that the current view is that only about 10% of all polyps become cancerous, but he also said that there is little long-term follow-up data to confirm or rebut that view. At present, medical science sees polyps of 10 mm in length as high-risk for cancer.

"We still see CTC as appropriate technology, and it would be a useful addition" to a physician's armamentarium, Brooks said.

In an e-mailed statement sent by Aimee Frank, director of public relations for the American Gastroenterological Association (AGA; Bethesda, Maryland), the association voices its support for coverage for CT screening "if CMS were to require, as a condition of coverage the establishment of procedure standards, mandated physician completion of a CTC certification program, and clearly defined appropriate cross-specialty episodes of care." The statement also notes that while AGA agrees "that the limitations of CTC cannot be ignored," the organization nonetheless "support[s] CTC and other screening tests if patients and their physicians believe that test is the appropriate one for them."

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