On February 25, a new bill with bipartisan support was introduced in Congress. If passed, H.R. 4632—also known as the CT Colonography Screening for Colorectal Cancer Act of 2016—would provide Medicare coverage for seniors who choose to be screened with CT colonography (virtual colonoscopy) instead of traditional colonoscopy.
“Early screening for colorectal cancer saves lives. Unfortunately, too many Americans fail to get screened because they feel current procedures are too invasive, or can’t for medical reasons. By covering an additional method of screening, Medicare can give seniors and physicians another tool for preventive and lifesaving care,” says Ben Wenstrup (R-OH), co-sponsor of the bill along with Danny Davis (D-IL).
It is widely known that 75% of those at risk for colon cancer fail to get screened; some speculate this is because of the invasive or embarrassing nature of the traditional colonoscopy. My theory is that the traditional screening is too complex and expensive. Unlike a mammogram or an ultrasound, where the individual can simply drive to the imaging center and then drive home an hour later, colonoscopy requires sedation, which forces the individual being screened to have to ask someone to drive them to and from the endoscopy center. The colon cleans prep is also heavier, and is commonly cited as the worst part of the entire procedure. The whole episode creates a major disruption to a person’s normal routine and diet. Finally, the price of a colonoscopy can range from $2,500 to more than $8,000. For individuals under 65 with high deductible plans, this can be expensive.
All of that adds up to…procrastination.
But CT colonography is a more practical test. Requiring only a light prep, it is essentially a CT scan of the colon. It can see areas of the colon the traditional colonoscope may not be able to reach (e.g. the cecum, which is the beginning of the colon). And it’s much less expensive, usually under $1,000.
In fact, a recent study* demonstrated that screening patients over 65 with CT colonography would cost 29% less than the traditional test and save up to $1.7 billion per screening cycle. Many private insurers now cover CT colonography, probably because at least 20 states have laws requiring them to do so.
Today, many of the individuals over 65 who undergo CT colonography are not able to have the traditional scope for various reasons. This could be due to their anatomy (which can make endoscopy challenging), or if they are on blood thinners (and are therefore at risk for internal bleeding).
Opponents—who typically consist of the greater gastroenterology community—complain that if CT colonography detects a polyp, it provides no means to remove it for testing as the traditional colonoscopy procedure does.
They’re missing the point. 90% of colon cancer death is preventable. Three-quarters of those at risk avoid their screenings, despite the best efforts of the medical community to inform patients. Clearly, another approach is needed.
What’s more, less than 8% of colonoscopies reveal polyps that would be considered suspicious. Wouldn’t it be better for an individual to actually get screened in the first place than worry about whether or not they will be inconvenienced by a follow-up test?
Here’s an idea for the GI community: Partner with your local imaging provider. We can assume that the majority of the unscreened (75% of people over 50) don’t actually have a gastroenterologist. But more widespread screening will reveal more patients at risk, and those patients will need a specialist. Instead of fighting this test, embrace it, and see it for the opportunity it really is—a chance to build your patient base while saving lives. How is that not a win-win situation all around?
March is colorectal cancer awareness month. What can you do? Write your representatives and tell them to support H.R. 4632. Let them know you’re behind this test. And together, we can do our part to eliminate colorectal cancer as a leading cause of death in the United States.
(*) Abdominal Imaging October 2015, Volume 40, Issue 8, pp 2966-2976 First online: 09 September 2015 Medicare cost of colorectal cancer screening: CT colonography vs. optical colonoscopy Bruce Pyenson, Perry J. Pickhardt, Tia Goss Sawhney, Michele Berris 10.1007/s00261-015-0538-1