Public Health Meets Policy: Colon Cancer Screening

It is my opinion and that of my colleagues here at the American Cancer Society that CTC could help reduce the disability and death from this disease. I suspect it will encourage more people to be screened for this cancer. Some of those people -- especially those in rural America -- may not have access to colonoscopy, given the shortage of trained colonoscopists in this country. CTC would probably assure 60 percent to 70 percent of the people screened with this new "virtual" test that they don't have a problem and don't need to go on to routine colonoscopy.

Treating colon cancer -- especially when it spreads -- is becoming more and more expensive, with the newer chemotherapy and targeted therapies that have become available. Reduce the incidence of colorectal cancer by finding a polyp in the colon before it becomes cancer and you not only reduce suffering but you reduce costs as well (by the way, estimates used to look at the cost effectiveness of CTC as part of this process applied data from 2003, which was well before the newer expensive drugs became available).

So, we find ourselves on the horns of a dilemma.

The American Cancer Society and others say CTC is an effective test and should be available from appropriately trained physicians and centers. Others look at the same data and conclude the test is not ready for prime time, calling for additional studies. Still others say we can do those studies while we are providing access to CTC with appropriate quality controls, yet there is no money to do the studies.

In Need of Medicare's Help

In the meantime, lives literally hang in the balance. And the people whose lives are hanging have no idea that they will be victims of colorectal cancer 5 years, 10 years or 15 years down the line.

We need to take a careful look at how we spend money for health care in this country. That is no secret and no surprise. But here we have an opportunity to do this the right way, while at the same time working together to answer the questions and be certain we do get it right.

Maybe CT colonography as a screening test is just the right place to start asking those questions and getting the answers, while saving lives as part of the process.

I don't think from a public health or public policy point of view it gets any better than that. But first, we need Medicare's help to get it done.

Len Lichtenfeld is deputy chief medical officer of the American Cancer Society. You can view the full blog by clicking here.

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