Public Health Meets Policy: Colon Cancer Screening

The American Cancer Society and its collaborators reviewed the evidence and thought that CTC should be an option for patients to consider "on the menu" for colorectal cancer screening, along with testing the stool for blood, routine colonoscopy, barium enema and sigmoidoscopy.

Others have reviewed the same evidence and come to different conclusions. They did not think the evidence is sufficient to support CTC as an alternative.

More recently, Medicare was asked to review the evidence on CTC and make a nationwide determination about whether it should be available for people on Medicare.

There is a very specific approach called a "national coverage decision" used by the Centers for Medicare and Medicaid Services to make these determinations. (Much of Medicare coverage is, in fact, based on "local" determinations by Medicare carriers, but that is beyond the scope of this discussion. In this case, the determination was going to be made by the central office in Baltimore.)

As part of that determination, they reviewed a significant amount of evidence, including a recent review and recommendation from the United States Preventive Services Task Force, that there was insufficient evidence to support CTC as an effective screening procedure for colorectal cancer.

The result is a preliminary conclusion from Centers for Medicare and Medicaid Services that the test will not be covered.

Is Colon Cancer Screening Worth the Investment?

Why is this so important, and why are so many organizations -- including the American Cancer Society -- working to have this decision reconsidered, or at least subject to further careful ongoing evaluation to answer some of the questions raised by the Centers for Medicare and Medicaid Services and the United States Preventive Services Task Force?

Colorectal cancer is the second leading cause of cancer death in this country. It affects both men and women, and overwhelmingly occurs in people age 65 and older. It increases in frequency the older we get.

Not Enough Screening for Colorectal Cancer

We know that colorectal cancer -- which takes the lives of almost 50,000 people a year in the United States -- could be prevented in many cases or at least found early if we followed the recommendations to screen for the disease.

Right now, some estimates are that about one-half of the people age 50 and older are getting screened. My personal hunch is that number is actually inflated. But even so, if only one in two people are taking advantage of screening for colorectal cancer, then we could do much better.

"Much better" in this case means that we could save thousands of lives every year when it comes to colorectal cancer if we only applied the knowledge we already have about screening for this disease. Even if we were perfect, we wouldn't find every case. But we would be a lot better off than we are now.

When you look at the age when colorectal cancer is diagnosed in the Medicare population, and realize that it takes 10 years or longer for many polyps to develop and become cancerous, then you wonder how many lives could be saved or at least relieved from the suffering that colorectal cancer brings, even if it occurs near the end of life.

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