US may require insurance cover for bowel cancer screening

The US government is moving towards requiring that health insurers cover the cost of routine screening for bowel cancer, making the tests more widely available to the general public.

The move has provoked controversy in some quarters, on the grounds that mandatory screening for colon cancer amounts to "disease specific favouritism" and will drive up already high healthcare costs.

Colon cancer kills 56 600 Americans every year and is the second leading cause of death from cancer in the United States, affecting men and women equally. Early intervention has been shown to increase survival and the detection of precancerous polyps and lesions. Shortly before the Senate voted on the Eliminate Colorectal Cancer Act Bill, President Bush was screened for colon cancer and subsequently urged people to take the precautionary tests.

The Senate voted in favour of the bill by 16 to 5 after lengthy debate. Congress is due to vote on a similar bill. The act requires health insurers to cover the cost of colon cancer screening for people aged 50 and above and people at increased risk of colon cancer at an early age because of inflammatory bowel disease or family history of polyposis. The act also directs the departments of Labor and Health and Human Services to enforce it.

Many health insurance plans currently cover colon cancer screening, but some offer only basic tests such as faecal blood testing, digital rectal examinations, and double contrast barium enemas. The new act will mean insurance cover for flexible sigmoidoscopy and colonoscopy as well as the cheaper tests. Colonoscopy currently costs between $700 (£448; €698) and $1000—possibly more if polyps have to be removed. Several recent studies have found that colonoscopy may be more cost effective and better at detecting colon cancer than other screening methods (Arch Intern Med 2002;162:163-8, JAMA 2000;284:1954-61).

The vote comes at a sensitive time. Questions have recently been asked about the value of screening tests for breast and prostate cancer. And there is no evidence that screening improves survival or quality of life. None the less, colon cancer screening is seen as potentially life saving, given the lack of evidence disputing its value.

But Senator Bill Frist of Tennessee, who is a surgeon and the only doctor currently serving in the Senate, has questioned the decision. He said the government should not "go into this unprecedented arena of taking a specific test and mandating that the private sector cover it."