CMS should pay for colorectal cancer screening for the benefit of all

Like many of you reading this know, my family was devastated by cancer. Earlier this year, I lost my brother Mike to melanoma at only 56. Mike battled cancer for quite a while, with colon cancer taking a toll on his body before the melanoma diagnosis. Like millions of Americans, I have a very personal stake in the fight against these diseases.

Key in the fight against colorectal cancer — the second-leading cause of cancer death in America — is early detection, which greatly increases patients’ chances of beating this killer. If found early, before it has spread, colorectal cancer’s five-year survival rate is about 90 percent, according to the American Cancer Society. And yet, while early detection is the best way to fight the disease, an impending bureaucratic decision may take away one of the most effective screening tools available. As a result, we stand to lose countless friends and loved ones whose deaths might have been prevented.

Recently, the Centers for Medicare and Medicaid Services (CMS) decided that it would not cover the cost of a simple test that could provide a new bulwark against colorectal cancers, the FDA-approved, breakthrough product Epi proColon. This simple blood test, which uses DNA markers to determine if a patient has cancer, is more effective than any other screening with the exception of colonoscopy, a far more costly and invasive procedure. The blood test is also much easier for physicians to perform and extremely convenient for patients.

CMS’s decision ignores critical evidence generated by U.S. Department of Health and Human Services (HHS) scientists, increases barriers to screening, and could result in more deaths from colorectal cancer, particularly in underserved urban and rural communities. It is also a decision which discriminates against African Americans.

This year, almost 148,000 Americans will be diagnosed with colorectal cancer; 53,000 people will die from it. But infection rates are higher among African Americans, who are 20 percent more likely to get colorectal cancer and about 40 percent more likely to die from it than most other racial or ethnic groups. African Americans also have the highest incidence of colorectal cancer among patient segments, with nearly 20,000 cases diagnosed annually; 15 to 20 percent are more likely to die from the disease than patients of any other race.

It is estimated that 76 percent of all colorectal cancer deaths could be avoided with early detection, but despite significant efforts by HHS and leading cancer organizations, overall screening rates in the U.S. have not increased to appropriate levels, and 35 percent of all age-eligible patients remain unscreened today. As a result, this disease is hitting us on an economic level as well; of the $18 billion spent annually on colorectal cancer treatments, $14 billion is due to a failure to catch the cancer early.

This historic challenge in screening has been deepened by the impacts of COVID-19. The Colorectal Cancer Roundtable recently found screening rates plummeted by 80 percent in 2020 as Americans avoided medical procedures during the pandemic. However, blood-based testing, broadly accepted through clinical trials conducted under FDA guidance, is quick and easy, making it ideal for reaching patients in underserved communities, enabling access to screening despite the pandemic.

Despite the fact that increasing participation in screening is critical to lowering costs and mortality associated with colorectal cancers, CMS did not consider these as relevant factors in their decision. I believe that blood-based colorectal screening tests must be given full and fair evaluation. They should be compared against existing standards, such as whether or not the test prevents incidence of disease or reduces the number of deaths caused.

For these reasons, I urge HHS to make screening more available to patients today. And, now that the public comment period has ended, I urge CMS to fully consider those comments, along with all key data and evidence regarding access — as well as the negative impact of their decision on public health.

If CMS’ decision not to cover Epi proColon is finalized, we will have lost the chance to reach patients whose lives could be saved. While legislative action remains an alternative approach, that path is far from assured. CMS has an opportunity now to do the right thing, to add another effective test for colon cancer to our armamentarium for those who refuse to get screened using existing modalities. Covering easy-to-perform, early screening is cost effective, saving billions of dollars while promoting good health in underserved communities and among African Americans, who disproportionately bear the brunt of the disease. Most importantly — covering early screening tests will prevent families from having to endure the kind of tragedies which I have experienced.

Fitzpatrick represents the 1st District of Pennsylvania and is co-chair of the Congressional Cancer Caucus.