CT colonography coverage hoists screening rates

Individuals who have insurance covering CT colonography are almost 50 percent more likely to get screened for colon cancer by either that option or colonoscopy—both of which can help prevent as well as detect cancer—than those who lack such coverage, according to a study published online July 11 in Radiology.

The longitudinal, population-based research behind the finding, conducted at the University of Wisconsin, showed that only 11 percent actually opted for CT colonography (aka “virtual colonoscopy”). However, commenting on this finding, lead author Maureen Smith, MD, PhD, MPH, and colleagues cite previous research suggesting that giving patients a choice of screening technology may motivate them to get screened, as they feel more involved in the decision-making process.

Then too, the authors point out, the low utilization of CT colonography likely owed to the relative newness of the test, which was not yet recommended by the U.S. Preventive Services Task Force during the six-year study timeframe, 2005 to 2010. (Last summer USPSTF began recommending colon-cancer screening by any means accessible.)

For the new study, Smith and team analyzed EHR data on 33,177 patients under age 65 who were eligible for colorectal cancer screening. Comparing screening rates between those with CT colonography coverage and those without, they found the former cohort had a 48 percent greater likelihood of getting screened by any method.

Interestingly, patients in the “with” cohort were no more likely than the “withouts” to be tested with fecal occult blood test, which is easy for patients but doesn’t aid in cancer prevention.

The authors acknowledge several limitations, including their use of data from a single multispecialty physician group. On the other hand, “it is the only center in the United States for whom a large proportion of patients eligible for colorectal cancer screening have had insurance coverage for CT colonography as a screening method over an extended period of time,” they write.

The authors note that lifting utilization rates of CT colonography will take winning broader buy-in from primary care providers as well as private insurance companies—and, probably most importantly, convincing Medicare to cover it.

“We conclude that insurance coverage of CT colonography as an additional option for colorectal cancer screening is associated with greater likelihood of a patient being screened and a greater likelihood of being screened using a preventive test (CT colonography or colonoscopy),” Smith and colleagues write. “Policymakers should consider additional options for colorectal cancer screening when considering strategies to increase overall screening rates.”

Radiology publisher RSNA has posted the full study for free.