President Obama, in his first routine physical exam as commander in chief, received a CT colonography (CTC), commonly known as a virtual colonoscopy, to screen him for colorectal cancer. However, Obama Administration officials at the Centers for Medicare and Medicaid Services (CMS) previously denied coverage of the same exam for seniors enrolled in Medicare, cutting off access for many to an exam proven to increase compliance with nationally accepted colon cancer screening guidelines.
Congress and the Administration should act now to ensure that seniors have the same access as the President to this less invasive, cutting-edge care. Patients who have delayed colorectal cancer screening should follow the President's example and look into CTC as a screening alternative.
"CT colonography is a safe and effective, front-line colorectal cancer screening tool that can attract many more people to be screened for one of the nation's leading cancer killers. The President and his doctors have unparalleled access to the latest medical and scientific information. The fact that he opted for CTC should put to rest any empty arguments against the viability of CT colonography. It's time for all patients who want a CT colonography to be covered for this lifesaving exam. Medicare needs to provide coverage now," said James H. Thrall, MD, chair of the ACR Board of Chancellors.
CT colonography employs cutting-edge x-ray technology to produce three-dimensional, fly-through images of the entire colorectal structure (colon and rectum). CTC is proven in clinical trials to be as accurate as standard colonoscopy in average risk patients. As indicated by the Blue Cross Blue Shield Association Technology Evaluation Center (TEC), advantages include that it is much less invasive, and does not require sedation. Patients can go back to normal daily activities immediately following the procedure.
"We are pleased that the President is in good health and that he and his doctors have embraced CT colonography's ability to accurately detect colorectal cancer. The fact that the leader of the free world has chosen to be screened with this exam is a testament that CTC works as a front line colorectal cancer screening tool. People who have delayed being screened due to cost and invasiveness of standard colonoscopy should follow the President's example and ask their doctor about CT colonography," said Judy Yee, MD, chair of the American College of Radiology Colon Cancer Committee.
Many health insurers, including CIGNA, UnitedHealthcare, and Anthem Blue Cross Blue Shield now cover screening and diagnostic CT colonography for their beneficiaries. However, Medicare patients are denied coverage for the exams. Colorectal cancer is the third most common cancer diagnosed among men and women in the United States and the second leading cause of cancer death, despite having a 90 percent cure rate when detected early. This is because less than half of those 50 and older who should be screened for the disease opt to receive the screening exams currently available. Medicare's denial of coverage, in effect, creates a two-tier coverage approach to screening coverage for this deadly disease: one for those who have private insurance and lesser coverage for Medicare beneficiaries.
"The President and many in Congress have stated repeatedly that they want all Americans to have access to the same health care options that they do. Now is the time to make good on those statements by requiring the Centers for Medicare and Medicaid Services (CMS) to cover CT colonography for Medicare patients," said Dr. Thrall.
The National Cancer Institute Colorectal Cancer Progress Review Group predicts that wider use of screening could save 20,000 lives annually. CTC's minimal invasiveness and lower cost has the ability to attract far more people to be screened and ultimately save lives - particularly among minorities where screening rates have historically been low. The Journal of the American Geriatrics Society released a study demonstrating that the disparity between white and non-white Medicare enrollees receiving a colonoscopy screening increased between 1995 and 2003.
"Providing Medicare patients an effective and less invasive screening tool for colorectal cancer can help overcome the disparity in colorectal care that exists in minority and underserved communities. The President has set an example that CTC provides a viable, effective and safe alternative to optical colonoscopy. Congress needs to act require Medicare coverage for CT colonography and help minority and underserved populations gain access to this potentially lifesaving care," said Dr. Yee.
The American Cancer Society has added CT colonography to its list of recommended colorectal cancer screening exams and recommends the exam be repeated every five years. Medicare coverage of CTC would be a tremendous step forward in the battle against one of the nation's leading cancer killers.