The Enterprise: Why Screen?

Clinical studies have proven that screening for certain cancers and heart disease saves lives. But questions linger. Will those screened derive any mortality benefit? If so, how great is it? What is the cost relative to gains, relative to treatment costs? This month we’re drilling down into CT screening, for lung cancer, colorectal cancer and coronary artery disease. There are still more questions than answers, but studies are underway.

Not one physician-based medical organization currently recommends CT lung cancer screening. They cite conflicting data from previous randomized controlled trials, risks associated with biopsy and surgery, and the number of false positives that generate downstream costs. Results of two clinical studies are expected later this year and by 2012.

Low-dose coronary artery calcium (CAC) scoring with CT and/or CCTA in the high-risk population has seen renewed interest. Last year, a Texas initiative required insurers pay for a CAC screen or carotid intima-media thickness ultrasound screen. Recent studies have found a CAC score added to traditional risk factors improved event risk prediction and that CAC screening resulted in low annual downstream costs.

Colorectal cancer screening via CT colonography (CTC) has recently passed a few hurdles, gaining an endorsement from the American Cancer Society (ACS) as a recommended screening test for patients over 50. The Blue Cross Blue Shield Association Technology Evaluation Center (TEC) also recognized CTC.

CMS is not yet a believer in CTC (citing inconclusive evidence of its benefit relative to colonoscopy, extracolonic findings and radiation dose), but some private payors, including CIGNA, UnitedHealthcare and Anthem BlueCross BlueShield cover screening and diagnostic CTC. At least 14 states that follow ACS screening recommendations mandate CTC coverage.

Industry lobbying efforts have produced a U.S. House of Representatives bill that seeks to mandate Medicare coverage of CTC screening (the Virtual Screening for Colorectal Cancer Act of 2010 [HR 5461]). HR 5461 would amend the Social Security Act to cover CTC screening under Medicare. In late May, it was referred to two House Committees—Energy and Commerce and Ways and Means.

CTC advocates say it works and attracts more screening candidates. The facility where President Obama recently received a CT colonography during his first physical as commander-in-chief saw a 70 percent increase in screening after offering virtual colonoscopy. Screening of the 50+ population in the U.S. stands at about 50 percent.

Research shows that a bad economy affects health by distracting people from adhering to preventive measures. For example, among women with newly detected breast tumors, the ratio of local tumors to more advanced tumors reportedly decreases during bad economic times, suggesting women may be impeded from undergoing screening. 1

We’ll never know the impact of the global recession on disease screening, what disease could have been prevented and what lives could have been saved.