Radiologist Judy Yee (pictured), of the San Francisco Veterans Affairs Medical Center, argues in an article published in the July issue of the American Journal of Roentgenology that "the time has arrived" for national reimbursement of CT colonography (CTC)--aka, virtual colonoscopy--in the U.S.
In 2008, the U.S. Preventive Services Task Force gave CTC an "insufficient rating," and a year later the Centers for Medicare & Medicaid Services determined that Medicare coverage of colorectal cancer screening should not be extended to CT colonography, citing concerns about the generalizability of the evidence of its value to the Medicare population, radiation risk and extracolonic findings.
According to Yee and a pair of colleagues, continuing research related to CT colonography has led to evidence addressing the issues of concern in the CMS review.
For instance, the authors point out, concerns about radiation dose have been addressed in several studies that show that there are large benefit-to-risk ratios in favor of screening CTC. A 2011 study published in the American Journal of Roentgenology led by Amy Berrington de Gonzalez of the U.S. National Cancer Institute, determined that the benefits of colon cancer screening with virtual colonoscopy far outweigh the risk of radiation-induced cancer, even when the exam is conducted every five years between the ages of 50 and 80.
The issue of extracolonic findings has been extensively researched, as well. In an article published in April in the ASCO Post, David Kim, M.D., said that although extracolonic findings often are cited as a negative consequence of CTC, "the feared high rate of additional imaging for clinically insignificant findings typically has not been seen."
As far as the need to document the generalizability of evidence for CTC performance for the Medicare population, Yee and her colleagues pointed out that four large peer-reviewed studies now are available that similarly support "the reliability of the observations made in Medicare-aged patients."
"The abundance of new research published ... in the peer-reviewed literature addressing the concerns of these organizations clearly document that the time has arrived to approve national reimbursement of CTC for screening of the general population," the authors concluded. "CTC has already been endorsed by the American Cancer Society, the U.S. Multi-Society Task Force, and the ACR as a valid test for CRC screening. National reimbursement will allow more rapid and widespread dissemination of CTC to the public, which will result in improved [colorectal cancer] screening adherence and ultimately in more lives saved."