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CT Colonography Update
by Duncan S. Barlow, MD

Duncan Barlow
Senior Radiologist
Via its teleradiology network, EagleEye has been providing quality CT Colonography (CTC) interpretive services for colorectal cancer (CRC) screenings for the last eight years, to the point where it is now interpreting in excess of 400 screenings annually. EagleEye radiologists were among those at Bethesda Naval Hospital, a major center for development of the procedure, providing interpretations as early as 2004.

Colorectal cancer is the third-leading cause of cancer in the United States. According to the American Cancer Society, more than 140,000 people will develop colorectal cancer in 2018, and approximately 50,000 of these individuals will die of the disease.

In June of 2016 the United States Preventive Services Task Force (USPSTF) updated its 2008 recommendation for colorectal cancer screening. The USPSTF endorsed CRC screening of adults between the ages of 50 and 75 and included CT Colonography as one of the 7 recognized screening exams for CRC.

This endorsement ended an eight-year push for establishing CTC as a legitimate screening exam for CRC screening. Beginning back in 2008, the American Cancer Society, the American College of Radiology and the Multi-Society Task Force on Colorectal Cancer endorsed CTC as a primary screening tool for colorectal cancer screening. In 2013 an FDA advisory panel endorsed CTC as a primary screening tool for colon cancer.

Since 2008 multiple large center clinical trials and research studies have demonstrated CTC to be as accurate as colonoscopy in screening patients 50 years and older for significant polyps. Studies have also shown that CTC is the people’s choice over Optical Colonoscopy for initial screening, and if utilized could cut CRC screening costs by 29% and save Medicare up to $1.7 billion per screening cycle.

The updated USPSTF recommendation, under Section 2713 of the Affordable Care Act, requires all private health plans to provide coverage without cost-sharing to patients undergoing CRC screening by any of the 7 recognized screening exams. This requirement applies to all private plans including individual, small group, large group and self-insured plans. In addition, Medicaid programs in about 20 states – including Maryland, Virginia, and Pennsylvania – as well as the District of Columbia – provide coverage for CRC screening.

To date, however, Medicare has not approved reimbursement for the procedure. In March of 2017, Congressman B. Wenstrup (R-OH) and Congressman D. Davis (D-IL) introduced The CT Colonography Screening for Colorectal Cancer Act (H.R. 1298). This legislation would provide Medicare coverage for seniors who choose to be screened with CTC -- bringing Medicare coverage in line with private insurance. In September of this year, The American College of Radiology and numerous colorectal cancer advocacy groups issued a statement calling for Congress to pass HR 1298.

Hopefully Congress will act and Medicare will finally cover CRC screening with CTC. As of this writing, interpretations of CTC screening represent a modest but growing segment of EagleEye’s practice. Coverage by the Medicare program would undoubtedly increase the importance of this procedure to EagleEye, but even more important, would represent a major step in providing an important new preventive element for the country’s seniors.

Dr. Barlow brings to EagleEye 29 years of skilled radiology expertise and training from the nation's most prestigious military medical institutions. He is presently a member of the Colon Cancer Committee of the American College of Radiology.