A recent meta-analysis published in the American Journal of Roentgenology (AJR) concludes that, overall, CT colonography (CTC) cancer detection rates are higher in Medicare-age adults compared with younger adults.
The paper by Perry Pickhardt, MD, and colleagues is based on a systematic review and meta-analysis of 34 studies published between January 1994 and August 2017 containing data on senior-age (≥ 65 years old) cohorts. Pickhardt is chief of gastrointestinal imaging at the University of Wisconsin and a member of the American College of Radiology Colon Cancer Committee. He concludes, “On average, one in every 12 senior-age adults without symptoms of colorectal cancer who underwent screening would be referred to colonoscopy using the 10-mm threshold, with a high yield for advanced neoplasia and high sensitivity for cancer detection.”
The Centers for Medicare and Medicaid Services (CMS) has a non-coverage determination for CTC coverage for colorectal cancer (CRC) screening in the Medicare population. One of the justifications for the decision not to offer this important service to Medicare patients is that CMS does not feel the existing published data is “generalizable to the Medicare population.”
CTC is recognized by the U.S. Preventive Services Task Force and the American Cancer Society as an accepted CRC screening test. In 2017, the ACR asked CMS to reopen the review process for CTC; however, CMS indicated there was insufficient evidence to support reopening the NCD. The recent AJR study may provide justification for CMS to reconsider the request.