Citing clinical evidence, coalition urges U.S. panel to approve CT colonography for screening

A growing body of evidence supports the use of CT colonography for colon cancer screening and a U.S. panel should reverse its decision to not endorse the procedure, according to the CT Colonography Coalition.

Currently, the U.S. Preventive Services Task Force (USPSTF), a panel CMS often turns to for advice when it comes to determining what to reimburse, gave CT colonography (CTC) an “I” grade, meaning more research is needed before the panel can recommend the test. The CTC Coalition wants that to change.

Colon cancer is the second leading cause of cancer death in the U.S., which makes it essential patients and doctors utilize the most effective services available to detect cancer early and prevent deaths, said coalition member Andrew Spiegel, CEO of the Colon Cancer Alliance.

“Data show that when CTC is offered in addition to other colorectal screening options, screening compliance rates increase dramatically,” he said. “That is why we believe the USPSTF should endorse CTC.”

The CTC Coalition submitted its comments in response to an announcement in the Federal Register asking for preventive health topics that should be considered by the USPSTF.

The coalition is not the only one saying there is already enough clinical evidence to prove CTC’s effectiveness.

“There is definitely enough evidence to recommend CT colonography for colon cancer screening,” said Dr. Judy Yee, vice chair of radiology and biomedical imaging at the University of California, San Francisco and chief of radiology at the San Francisco Veterans Affairs Medical Center.

Yee, a CTC expert, cited several studies arguing there is enough clinical evidence to back CTC. The American College of Radiology Imaging Network National CTC Trial, published in the New England Journal of Medicine, was a landmark in using the current technique and trained readers to evaluate about 2500 patients at 15 sites, she said.

“Results showed excellent sensitivity and specificity for the detection of the large, clinically significant polyps,” she said. “Based on this study, as well as others, the American Cancer Society revised guidelines in 2008 and now includes CTC as a valid screening test option for colorectal cancer.”

In addition to several U.S. studies, there is also evidence from other countries showing CTC’s effectiveness.

“It is beginning to seem rather irresponsible to continue to offer routine double contrast barium enema examinations…. More than 90 Canadian radiology departments have bought the necessary CO₂ insufflators, so there is clearly great interest,” said the authors of a Canadian trial (Stevenson G. Can Assoc Radiol J 2008;59:174-82).

CTC is less invasive and therefore safer compared with colonoscopy, Yee said. No sedation is required, so patients avoid the risks and costs of anesthesia. They don’t have to take the whole day off work, and they don’t require anyone to take them home as they do with a colonoscopy.

“Even with the older colon cancer screening tests, about 50% of the population who needed screening for colon cancer did not come in to get screened,” Yee said. “There clearly is a need for a more appealing test.”

Even though Medicare doesn’t cover CTC and the USPSTF has yet to recommend it, about 30% to 40% of hospitals offer the procedure.

“As we wait for national reimbursement by CMS, private payers are increasingly covering screening over the past two years,” Yee said. “Patients need to request coverage by their insurance companies and at a state level.”

There are also local coverage determinations in almost every state that allow reimbursement for diagnostic CTC, she said. That is an indication CTC is performed in almost all states.

“Academic centers and larger private practices typically offer CTC,” she said. “Smaller sites may not offer onsite CTC, but they could direct patients to places that do offer it.”

Earlier this year, President Obama opted for a virtual colonoscopy screening over a traditional colonoscopy.

“If the president has the option to choose a CTC screening, then surely U.S. seniors should have the option available to them, too,” said the CTC Coalition’s Spiegel.

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