The American College of Radiology (ACR) said the decision by the U.S. Preventive Services Task Force (USPSTF) not to include CT colonography (CTC) on its list of recommended colorectal cancer screening exams may result in thousands of unnecessary deaths as well as needless healthcare spending.
USPSTF relied on obsolete data to exclude CTC in its latest draft colorectal screening recommendations, ACR said. Although the task force cited a lack of "maturity of the evidence" and "gaps in evidence on incidental findings" for CTC, ACR pointed out that the American Cancer Society recommends CTC as a screening test. Several other studies in the New England Journal of Medicine and Radiology prove that CTC has accuracy comparable to optical colonoscopy, including for individuals 65 or older, according to ACR. In addition, President Obama elected to receive a CTC exam in his first checkup as commander in chief.
Under the Affordable Care Act, private insurers are only required to cover (with no patient copay) exams that are given a grade B or better by USPSTF. Medicare determines coverage separately, ACR said.
A recent study in Abdominal Imaging showed that screening Medicare patients with CTC would cost 29% less than optical colonoscopy and save up to $1.7 billion per screening cycle, ACR noted. Studies also show that CTC significantly boosts colorectal cancer screening rates.
"This USPSTF draft recommendation could restrict access to a major tool to help achieve the National Colorectal Cancer Roundtable goal of an 80% colorectal cancer screening rate by 2018," Dr. Judy Yee, chair of the ACR Colon Cancer Committee, said in ACR's statement. "As a result, thousands may continue to die each year that could be saved through more widespread screening enabled by CT colonography."
CTC can also detect cancers and other serious illnesses in organs other than the colon, including abdominal aortic aneurysms, ACR said. Studies have shown it doesn't result in an inordinate number of incidental findings requiring additional or unnecessary workup, however, according to the organization.
ACR was also puzzled by the task force's omission of a stool DNA screening test from its list of recommended screening exams. The U.S. Centers for Medicare and Medicaid Services (CMS) had previously approved Medicare coverage of the stool test, according to ACR.
CTC has been found to be better for identifying colorectal cancer and precancerous polyps than the stool test, is more cost-effective, and results in fewer false-positive exams, ACR said. It also is recommended every five years, while the DNA test would be performed every three years.
If finalized, the draft USPSTF recommendation would prolong a two-tier system where seniors are not covered for an exam that's already covered by Cigna, UnitedHealthcare, Anthem Blue Cross/Blue Shield, and other large insurers, according to ACR.
"This erratic USPSTF recommendation would force seniors who want a CT colonography to continue to pay for the exam out of pocket -- on top of the annual Medicare premium," Yee said. "Many seniors, who might not get tested otherwise, can't overcome this financial barrier to care and may ultimately pay with their lives."
