Study questions CMS coverage decision on CT colonography

June 16, 2009

According to a recent study, the elderly are at enhanced risk for complications associated with screening colonoscopy.

A new study found some elderly patients are at risk for bowel perforation and other adverse events when undergoing screening colonoscopy. This finding comes on the heels of the CMS decision not to cover the less invasive procedure, CT colonography, in Medicare patients-a decision that most of the major cancer organizations felt was counterproductive.

The study, which was reported in the Annals of Internal Medicine, found that although the risks from colonoscopy are quite low, complications such as perforation, bleeding, and heart problems may outweigh the benefits in certain populations of elderly patients.

Led by Joan L. Warren, PhD, of the Applied Research Program at NCI, the researchers collected data on 53,220 Medicare recipients who had colonoscopies between July 2001 and October 2005. They compared these patients with a matched set of Medicare patients who did not have colonoscopies, looking for bowel perforation and heart-related issues.

Dr. Warren's team found that the beneficiaries who underwent colonoscopy had a greater risk of adverse events than those that did not have the procedure. Moreover, those who had a polyp removed during colonoscopy had a greater risk of adverse event than those who did not have polypectomy.

Although most experts agree that colonoscopy is generally safe for patients of all age groups who do not have underlying health issues, Durado Brooks, MD, head of the prostate and colorectal cancer prevention programs at the ACS, thinks the study raises questions about the recent CMS decision not to cover CT colonography.

In a press statement, Dr. Brooks said, "Given the possibility of harm coming to patients from colonoscopy, it seems ill-advised to withhold another potential screening approach that would allow physicians to have a complete view of the patient's colon."

CMS based its decision not to cover CT colonography on a lack of data in the over-65 population. Perhaps this study will lead to more research that will eventually convince CMS that a less invasive colorectal screening option will ultimately save lives and money.