The use of CT colonography (CTC) for colorectal cancer screening is at an "inflection point" after its reimbursement approval in 2024 from the U.S. Centers for Medicare and Medicaid Services (CMS), according to a commentary published March 12 in the American Journal of Roentgenology.
If the Medicare reimbursement approval translates to improved screening rates, patients will benefit, wrote a group led by David Kim, MD, of the University of Wisconsin School of Medicine and Public Health in Madison. Kim's colleagues included Anu Obaro, PhD, of St Mark's Hospital and Academic Institute in London, U.K.; Stuart Taylor, MD, of the University College London, also in the U.K.; and Perry Pickhardt, MD, also of the University of Wisconsin.
"CTC is at an inflection point in the U.S., where its use may substantially increase to help screen the large numbers of eligible but unscreened individuals," the team noted.
Low-dose CTC without intravenous contrast is used to detect colorectal polyps and cancer, but despite supporting data from previous research, the exam has had variable acceptance and use over the past two decades -- in part because of a lack of Medicare reimbursement. But last year, the CMS backed reimbursement for screening CTC as part of the Medicare Physician Fee Schedule; the recommendation was included in the rule and went into effect in January.
The reversal by the CMS to provide coverage for screening CTC beginning in January 2025 "heralds a landmark event," the authors wrote. "In addition to now covering screening CTC in individuals 65-years-old and older, the change signifies to primary care providers that CTC is a recommended option on par with the other reimbursed options, matching USPSTF [the U.S. Preventive Services Task Force] and ACS [American Cancer Society] screening recommendations."
What are the challenges to integrating CTC for colorectal cancer screening into clinical practice? They vary somewhat between the U.S. and the U.K., according to the group.
- In the U.S., primary care providers must accept and adopt screening CTC.
- In the U.S., radiologists must increase their interest and involvement in CTC.
- In the U.K., there's a lack of investment, suboptimal quality assurance, and a need for outcomes-based trials and cost-effectiveness data.
- In both the U.S. and the U.K., there's a need for standardized training for CTC.
Kim and colleagues also outlined new concepts in colorectal cancer screening and CTC, noting that advances in the understanding of precursor polyps and molecular pathways to cancer progression have influenced screening strategies and writing that "radiologists must be aware of this contemporary knowledge to best implement CTC."
In any case, increased uptake of CTC for colorectal cancer screening will improve patient outcomes, according to the group.
"CTC images contain inherent information that may be unlocked by newer segmentation and postprocessing methods, leading to opportunistic screening for a variety of conditions," it noted.
In an accompanying editorial, Marc Gollub, MD, of Memorial Sloan Kettering Cancer Center in New York City encouraged his radiologist peers to boost use of CTC.
"Let us radiologists, along with our primary and subspecialty care colleagues, rise to the occasion and offer modern screening as described in the article and this commentary, to benefit not only individual patients but the larger eligible population by helping to reduce CRC incidence with this newly reimbursable CTC option," he urged.
The complete study can be found here.
