In 2009, the Centers for Medicare and Medicaid services (CMS) excluded computed tomography colonography (CTC) as a colorectal screening option. CTC is commonly known as virtual colonoscopy. U.S. senators James Inhofe (R—Oklahoma) and Bill Nelson (D—Florida) recently introduced S 2262, a bill that would require CMS to include virtual colonoscopy as a colorectal cancer screening option for Medicare beneficiaries.
Judy Yee, MD, FACR, chair of the AR Colon Cancer Committee; professor and vice chair of Radiology and Biomedical Imaging at the University of California, San Francisco, and chief of radiology at the San Francisco VA Medical Center, supports this bill saying, “Major colorectal cancer advocacy groups, along with the American College of Radiology (ACR), support Medicare coverage of virtual colonoscopy because it would remove a financial barrier to a test that more seniors would use and that is already widely covered by private insurers.” Yee points out that major insurers like Cigna, UnitedHealthcare, and Anthem Blue Cross Blue Shield cover virtual colonoscopy, and 20 states require insurers to cover this procedure.
Although the US Preventative Task Force recommends colorectal cancer screening starting at age 50 and at various intervals until the age of 75, the Centers for Disease Control and Prevention report that only one-third of adults within this age group elect to have a colorectal screening. The addition of virtual colonoscopy as a covered procedure for Medicare beneficiaries may convince individuals who were previously reluctant to get a colonoscopy. One complaint about colonoscopies is that they are invasive and uncomfortable.
It is important to note that, while a virtual colonoscopy is less invasive, it still requires a bowel prep and bowel flush. Additionally, if a polyp is discovered in the exam, it cannot be removed during a virtual colonoscopy. The discovery of a polyp would require a follow-up colonoscopy, which would lead one to conclude that the best and most cost-efficient colorectal screening is the colonoscopy.
The colonoscopy is still the Gold Standard for colon cancer prevention, detection and treatment. Only one procedure can examine the entire length of the colon, detect suspicious lesions and polyps, and remove abnormal growths before they develop into cancer. While virtual colonoscopy coverage may increase colon cancer screening rates, the colonoscopy remains the clear champion in colon cancer prevention.