The Centers for Medicare and Medicaid Services (CMS) has decided not to reconsider the existing National Coverage Determination (NCD) on Screening Computed Tomography Colonography (CTC) for Colorectal Cancer (CAG-00396N) in response to a request that the agency make this screening study a Medicare covered service. In April 2022, the American College of Radiology and other organizations representing the colon cancer community had formally requested that CMS to provide coverage for screening CTC.
CTC uses low radiation dose CT scanning to obtain images of the inside of the colon that otherwise can only be seen with the more invasive colonoscopy. For CT colonography, patients prep in a similar fashion to those patients who undergo colonoscopies, but they remain conscious during the CT imaging of the colorectal area.
In making the coverage request, the ACR and the colon cancer advocacy groups cited new evidence and the updated United States Preventive Services Task Force (USPSTF) recommendation that endorses CTC as a colorectal cancer screening option and expands screening for colorectal cancer in all adults ages 45 to 75 years. The request to CMS also aligned with the 2018 American Cancer Society (ACS) published guideline for colorectal cancer screening which concluded that adults aged 45 years and older with an average risk of colorectal cancer should undergo regular screening using one of a variety of available screening options, including CTC, every 5 years. ACS recommends that adults begin screening at age 45, preferably with a test that allows for both cancer prevention and detection.
The ACR and the other groups disagree with CMS that the evidence is insufficient to support a reconsideration. They cite additional evidence, including the updated USPSTF final recommendation for colorectal cancer screening. The organization has called attention to the President's revitalization of the “Cancer Moonshot” initiative, and noted the disproportionate impact on Black patients and underserved communities of failure to gain early detection of colon cancer in those populations.
There certainly appears to be a need for increased access to colorectal screening services. The organizations noted in their April request: "Colorectal cancer is the third leading cause of cancer death for both men and women, with an estimated 52,980 deaths in the US from colorectal cancer in 2021. Colorectal cancer is most frequently diagnosed among persons aged 65 to 74 years. It is estimated that 10.5% of new colorectal cancer cases occur in persons younger than 50 years. The incidence of colorectal cancer (specifically adenocarcinoma) in adults aged 40 to 49 years has increased by almost 15% from 2000-2002 to 2014-2016. In 2016, 26% of eligible adults in the US had never been screened for colorectal cancer and in 2018, 31% were not up to date with screening."
ACR reports that a meeting has been scheduled in July with the CMS Coverage and Analysis Group to discuss its rationale and final decision.