by Brendon Nafziger
, DOTmed News Associate Editor | March 09, 2012
A bill introduced into the House of Representatives yesterday that would require Medicare to cover virtual colonoscopies for colon cancer screenings was lauded by medical imaging manufacturers.
"By requiring [the Centers for Medicare and Medicaid Services] to reimburse for virtual colonoscopies, the Virtual Screening for Colorectal Cancer Act promises to eliminate unnecessary barriers to colon cancer screening," the Medical Imaging and Technology Alliance, a trade group, said in a statement.
According to the group, the bill, H.R. 4165, would compel CMS to reimburse doctors for the tests, which use a CT scan of the abdomen to generate a 3-D reconstruction of the colon so doctors can find cancer, polyps and other abnormalities.
The legislation was sponsored by Reps. Danny K. Davis, a Democrat from Illinois, and Ralph M. Hall, a Republican from Texas.
"March is Colon Cancer Awareness Month and there is no better time to ensure access to proven screening tools that can help prevent this deadly disease," Davis said in a statement on his website.
In 2009, the CMS ruled against covering screening CT colonographies, in part because it said there was a lack of evidence showing its effectiveness in the Medicare-age population, those 65 years old and up. However, a study published last month in Radiology looked at the results of a Medicare age cohort from an earlier, multi-center trial, and argued that the virtual exams performed well in the older group.
"Our goal in carrying out this secondary analysis was to determine if the accuracy of CT colonography to detect polyps of clinical concern in patients 65 and older is comparable to the test's accuracy for the 50 and over population studied in the 2008 [American College of Radiology Imaging Network] trial. We found no significant difference in the screening exam's performance between the two age groups," the study's principal investigator, Dr. C. Daniel Johnson of the Mayo Clinic, said in a statement on the ACRIN website.
Proponents of CT colonographies say they can increase the rather low screening rate for colon cancer. For instance, a study published last fall in The Lancet
found a 55 percent increase in screening compliance in those invited for the scans over traditional colonoscopies, which require inserting a camera-tipped tube through the colon.
But critics contend it is not cost-effective. Part of the problem is that if a polyp is detected during the CTC scan, a colonoscopy usually has to be ordered anyway to remove it. And the scans can pick up extracolonic findings, which might involve costly further testing or treatments, even though the detected abnormality might never pose a problem for the patient.
Nonetheless, too few Americans are getting screened for the disease. The American College of Physicians, which incidentally didn't strongly recommend CTC for screenings in its recent guidelines
, says 60 percent of Americans 50 and over — who could most benefit from screening — aren't getting tested.
The bill was referred to the House Ways and Mean Committee.