Not all cancer screening tools appeal to all people. Without options, particularly ones that appeal to them, many choose not to get screened at all. This is certainly the case with colorectal cancer (CRC) —the second leading cause of cancer death among American men and women. This often preventable disease is expected to kill nearly 50,000 Americans in 2017 — largely because more than a third of those who should be screened can’t have or choose not to get a standard colonoscopy.
Worse still, virtual colonoscopy (known as computed tomography, or CT, colonography), a less invasive available option (see video) for detecting colorectal cancer and precancerous polyps, is not covered by Medicare. This lack of coverage adds an unnecessary barrier to a proven exam already covered by many private insurers. This must change. Greater access to virtual colonoscopy will address many patient objections to being screened and enable doctors to find more colorectal cancers early, when they are most treatable.
A primary benefit of virtual colonoscopy is that it requires no sedation, as it uses high-tech, low-dose X-rays to produce three-dimensional images of the inside of the colon obtained from a CT scan. Doctors examine these images to detect cancer and precancerous polyps. In contrast, standard colonoscopy, which does require patient sedation, inserts a long camera-tipped tube into the patient’s rectum and extends the tube through the colon.
Virtual colonoscopy is endorsed by the American Cancer Society as a recommended screening test. The Blue Cross Blue Shield Association Technology Evaluation Center (TEC) named virtual colonoscopy an effective screening tool. Major insurers – including CIGNA, UnitedHealthcare and Anthem Blue Cross Blue Shield — cover the procedure, and more than 20 states now require private insurers to do so. So why doesn’t Medicare cover the procedure?
Last year, the United States Preventive Services Task Force (USPSTF) included CT colonography in the “A” grade it assigned colorectal cancer screening, indicating that there is high certainty that its net benefit is substantial and suggesting the service should be provided to Medicare beneficiaries. Studies in the New England Journal of Medicine (NEJM) and elsewhere show that the virtual exam is comparable to standard colonoscopy in people at average risk for colorectal cancer (which is most people). While standard colonoscopy is the most widely used CRC screening option, it does not yield better results than virtual colonoscopy.
Another misperception is that virtual colonoscopy exposes patients to unnecessary radiation risk. To the contrary, a study of Medicare-aged patients revealed no short- or long-term complications as a result of the virtual screening. The same study found that Americans get roughly the same amount of radiation each year from environmental sources, such as coal, granite, Brazil nuts and bananas, as they do from one virtual colonoscopy. Plus, the virtual exam is only recommended once every five years. It also has an overall lower complication rate as it is a less invasive test than standard colonoscopy.
We can’t allow unfounded fears and misconceptions to prevent those at risk from seeking critical screenings, particularly when the stakes are so high. African-Americans have higher CRC incidence and death rates, and Latinos have lower screening rates. We must take action to reduce these racial disparities, and the best way to do so is by providing more options to screen for cancer before it’s too late.
Studies in Europe and at National Military Medical Centers show that the availability of virtual colonoscopy increases CRC screening rates. Medicare coverage of virtual colonoscopy would remove a financial barrier to this life-saving exam that is actually less expensive than a standard colonoscopy. Once covered by Medicare, more medical centers in underserved areas may be able to offer the virtual exam.
It is imperative that we support efforts to increase screening options by enabling greater access to virtual colonoscopy. This would motivate more people – including African-Americans and Latinos – to get screened and lower the number of deaths from a largely preventable disease. Congress is already considering legislation that would mandate Medicare coverage for virtual colonoscopy; supporting this one should be a no-brainer.