Who Should Pay for This Cancer Screening?

Noninvasive colon scans called computed tomography colonography are more palatable

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Not too many people even like to think about what's involved in a colonoscopy. This may be why 40-50 percent of folks just skip the colorectal cancer screening.

A new study suggests that CT colonography is well suited for seniors who are either unwilling or unable to undergo colonoscopy.

Furthermore, the study urges that the colorectal cancer screening be covered by Medicare.

"Ask your doctor about the "virtual colonoscopy.""

The research was designed to provide the Centers for Medicare and Medicaid Services (CMS) with additional information about the appropriate use of this colon cancer screening method for people over the age of 65.

In 2009, the agency ruled that CT colonography would not be covered by Medicare because there wasn't enough outcomes data relating specifically to the Medicare population.

"Our study answers several of the questions Medicare asked about this procedure," said Brooks Cash, MD, one of the study authors. 

The study found that 14 percent of patients who have had a colon scan are referred to have a colonoscopy. This is similar to what other studies have found.

"The prevalence of neoplasia (abnormal growths of cells) detected by CT colonography was 9.3 percent in patients over the age of 65, which is also similar to the results of other studies involving younger patients," said Dr. Cash

Along with screening the colon, the procedure also picks up other potential problems in what doctors call "extracolonic findings." This occurred in 2.9 percent of the group.

"The confirmation of low rates of referral to colonoscopy, the prevalence of advanced neoplasia and the prevalence of extracolonic findings makes CT colonography a viable option for Medicare-aged patients," said Dr. Cash.

The CMS was also concerned about radiation doses. Dr. Cash explained that the dose of the machine used at the National Naval Medical Center in Bethesda where the study took place is about 4.24 mSv per exam. Americans are exposed to roughly 6.2mSv of radiation annually.

"This is the real value of CT colonography – offering an alternative, high quality, total colonic preventative screening to a large percentage of the population that either refuses or is unable to undergo colonoscopy," said Dr. Cash.

He calculates that colon cancer screening rates would increase by about 15 percent if CT colonography was covered by Medicare or other insurers.

Other studies have questioned the cost effectiveness of CT colonography compared to other screening methods, including stool testing and colonoscopy.

CT colonography, which is recommended every five years, is more expensive than the colonoscopy - $2,900 to $3,850, compared to about $2,500 for a colonoscopy, which is usually performed once every 10 years.

The American Cancer Society recommends colon cancer screening begin at age 50. Those with a family history of the disease, screenings should begin at age 40.

The study appears in the July issue of the American Journal of Roentgenology. No funding or financial disclosures were available.

Reviewed by: 
Review Date: 
July 6, 2012
Last Updated:
December 27, 2012