Radiologists and oncologists are supporting a CMS move to revisit its national coverage policy on positron emission tomography for the pre-treatment staging of cervical cancer.

Currently, Medicare covers PET for initial staging of cervical cancer only if a computed tomography (CT) or magnetic resonance imaging (MRI) scan shows there is no extra-pelvic metastasis of the cancer. If the CT or MRI scan does show metastasis, however, then PET is covered only if data is collected.

Since May 8, CMS has been exploring whether to lift this coverage-with-evidence-development (CED) requirement (¹ Also see "CMS Considers Broadened PET Scan Coverage For Staging Of Cervical Cancer" - Medtech Insight, 18 May, 2009., p. 6). The agency took public comments through June 7.

Among the 25 organizations and individuals submitting comments was imaging technology maker GE Healthcare, which is urging CMS to broaden coverage of PET "by eliminating the current legacy coverage restrictions."

In a separate April 3 national coverage determination, CMS lifted coverage-with-evidence- development requirements for one-time use of PET during the pre-treatment stage of several solid tumor cancers, including brain, pancreatic, testicular, thyroid and small cell lung cancer (² Also see "Oncology PET Scan Coverage Expands As CMS Lifts Some Data Mandates" - Medtech Insight, 13 April, 2009., p. 5).

Because the restriction on pre-treatment PET use in cervical cancer does not exist for other tumor types, the current Medicare coverage policy "may cause confusion" among physicians and result in treatment delays, according to Landis Griffeth, director of nuclear medicine at Baylor University Medical Center, who commented on behalf of the US Oncology Physician Network.

The Society of Gynecologic Oncologists also strongly supports a policy change. "Given the literature regarding the relationship between complete, appropriate cancer staging and survival, the ability of SGO members to use [PET] immediately for initial treatment planning purposes cannot be underestimated," the society comments.

Andrew Quon, assistant professor at Stanford University Medical Center, notes that PET can be useful in evaluating distant nodal disease that is not as easily evaluated by conventional imaging.

Several commenters argue that removing the need for a CT or MRI scan prior to PET could cut costs.

"Almost all patients who receive a CT or MRI of the pelvis that shows no extra-pelvic metastatic disease will still require PET in order to develop an initial treatment plan," the Academy of Molecular Imaging says. "It cannot be in the interest of patients, providers or CMS to perpetuate a policy that increases inconvenience, exposure, and expense by requiring both CT/MRI and PET."

According to Jeff Michalski, professor and vice-chairman of radiation oncology at the Washington University School of Medicine, it is "problematic" to deny PET coverage when a CT scan or MRI shows evidence of extra-pelvic disease "because it assumes CT or MRI to have a high accuracy and a low false positive rate. This is an incorrect assumption, and indeed PET or PET/CT is a more accurate staging examination."

If CMS removes its "unnecessary barrier" to using PET for the initial staging of cervical cancer and harmonizes its coverage policy for PET use in all covered cancers, it would simplify the data collection burden of the National Oncologic PET Registry (NOPR), the Academy of Molecular Imaging says.

America's Health Insurance Plans also supports removing the data collection requirements, noting that "current evidence indicates that PET is more effective in helping guide treatment for cervical cancer than other tumors."

However, the insurers group wants CMS to "continue to review emerging evidence for each cancer type in regards to the use of PET," adding that the agency should monitor the imaging technology "for potential over-utilization and inappropriate use for all cancer types" as more evidence on appropriate use becomes available.

Several industry reps and oncologists conceded that it is appropriate for CMS to issue a national non-coverage determination for use of PET in diagnosing, as opposed to staging, cervical cancer.

A proposed rule is due Nov. 8, and a final rule by Feb. 6, 2010.

- Monica Hogan (m.hogan@elsevier.com)

Oncologists Seek To End Restrictions On PET For Staging Cervical Cancer

More from Archive

More from Medtech Insight