We fully concur with the provisions in H.R. 15 that define the category of high risk patients and provide this screening tool for patients recognized at high risk. Additionally, for the asymptomatic patient who by virtue of family history, prior experience of cancer, its precursor neoplastic polyps, chronic history with a digestive disease condition, such as inflammatory bowel disease, or other predisposing factor, faces a significantly higher risk for the disease, it is essential that Medicare provide colonoscopy surveillance for these high risk individuals. Until Medicare begins to provide benefits that will encourage early detection and treatment, we stand little chance of markedly reducing the devastating impact and fatality rates of our nation's number two cancer killer. Barium x-ray yields a contrast image rather than the direct visualization made possible with flexible sigmoidoscopy and colonoscopy. Unlike colonoscopy in which a single procedure can be both diagnostic and therapeutic to remove polyps and other lesions, barium enema x-ray is at best diagnostic without any ability to biopsy or remove a polyp.
Barium enema is less sensitive than colonoscopy for the detection of cancers and large polyps.
Some guidelines indicate a limited role for barium enema, recommending it for average risk individuals if used in conjunction with a flexible sigmoidoscopy. The screening regimen in H.R. 15 tracks the ACS's current core recommendations for average risk patients, that is, the fecal occult blood test and flexible sigmoidoscopy. No one contests the role of the fecal occult blood test, the flexible sigmoidoscopy for average risk patients, or the colonoscopy for high risk patients. Congress needs to enact the colorectal cancer preventive benefit now. H.R. 15 provides that barium x-ray may be added, if and when HHS makes an affirmative finding of its effectiveness.