March 2, 2010
The Honorable Barack H. Obama
President of the United States The White House
1600 Pennsylvania Avenue, Northwest Washington, DC 20500
Dear President Obama,
On behalf of the 37,000 diagnostic radiologists, interventional radiologists, radiation oncologists, nuclear medicine physicians and medical physicists represented by the American College of Radiology, we would like to congratulate you on your recent physical exam and your “clean bill of health”. We would also like to commend you on recognizing the importance and benefits of the latest colorectal cancer screening technology, CT colonography.
As you now know, CT colonography employs cutting-edge low radiation dose technology to produce a three-dimensional, fly-through visualization of the entire colorectal structure (colon and rectum). CTC is proven to be as accurate as standard colonoscopy in average risk patients such as yourself in clinical trials and as indicated by the Blue Cross Blue Shield Technology Evaluation Center (TEC). Advantages include that it is much less invasive, and does not require sedation. Patients can go back to normal daily activity immediately following the procedure. In your case, this was particularly important, as you did not have to nominate a designee for office during the study.
Many private insurers, including CIGNA, United Healthcare, and Anthem Blue Cross Blue Shield now cover screening and diagnostic CT colonography for their beneficiaries. However, Medicare patients continue to be denied coverage of CT colonography. Colorectal cancer is the third most common cancer diagnosed among men and women in the United States and the second leading cause of cancer death, despite having a 90 percent cure rate when detected early. This is because less than half of those 50 and older who should be screened for the disease opt to receive any of the screening exams currently covered by Medicare. Medicare’s denial of coverage, in effect, creates a two- tier coverage approach to screening coverage for this deadly disease: one for those who have private insurance and lesser coverage for Medicare beneficiaries.
You have yourself publicly addressed the importance of screening for colorectal cancer and have also stated that every American should have access to the same level of care that you receive. The Centers for Medicare and Medicaid Services (CMS) should cover CT colonography for Medicare patients so that our nation’s seniors have the same level of access as yourself. CT colonography’s minimal invasiveness and lower cost has the ability to attract far more people to be screened and ultimately save lives, particularly in the minority community where screening rates have historically been low. The Journal of the American Geriatrics Society released a study demonstrating that the disparity between white and non-white Medicare enrollees receiving colonoscopy screening increased between 1995 and 2003.
Providing Medicare patients an effective and less invasive screening tool for colorectal cancer can help overcome the disparity in colorectal care that exists in minority and underserved communities. In undergoing a CT colonography examination, you are an exemplary model that this technology provides a viable, effective, and safe (up to 20 times lower perforation rate) alternative to optical colonoscopy. Congress needs to act now to require Medicare coverage of CT colonography and help minority and underserved populations gain access to this potentially lifesaving care.
The American Cancer Society endorses CT colonography and added it to its list of recommended colorectal cancer screening exams and suggests that the exam be repeated every five years.
Medicare coverage of CT colonography would be a tremendous leap forward in the battle against one of the nation’s leading cancer killers.
James H. Thrall, M.D., FACR Chairman, ACR Board of Chancellors