US Medicare officials are seeking advice on whether to lift a payment restriction on PET scans used for nine cancers, a move that could lead to wider use of the technology among elderly and disabled patients.
While the government program pays for positron emission tomography (PET) scans for breast cancer and heart disease, it only covers the other cancers if doctors submit patient data to a registry aimed at gauging the technology's effectiveness.
Groups representing doctors as well as PET scan makers such as General Electric Co's GE Healthcare unit say there is now enough data to support wider use and have asked Medicare to remove the registry requirement.
But use of PET scans rather than other imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI) scans to detect some cancers has drawn mixed reactions as scientists debate PET's usefulness for certain conditions.
The current policy, adopted in 2005, applies to brain, cervical, bladder, small-cell lung, ovarian, testicular, prostate, kidney and pancreatic cancers.
Next Wednesday, the Medicare agency will convene an advisory panel to review the data and consider whether there is enough to show the scans lead to better care for patients.
Medicare, which covers about 44 million older or disabled patients, is expected to make a draft decision in January before a final ruling in April. It could also decide to maintain the restriction or exempt only some of the cancers.
Lifting the restriction would make it easier for doctors to order the scans and allow use of the test more often.
"This will definitely increase the utilization of PET," said Dominic Smith, vice president of a Philips Electronics NV's unit that makes medical imaging devices.
Industry-wide, more than two million PET scans are given in the United States each year, a number growing roughly 500,000 each year, he added.
It costs $50 to register each patient and roughly 106,000 have been signed up as of June 30, according to Edward Coleman, past president of the Academy of Molecular Imaging, an industry group sponsoring the registry.
Siemens AG's Siemens Medical Solutions unit also makes PET scan equipment. Other companies make the tracer drugs given to patients for the scan.
None of the PET scan makers mentioned above break out separate sales figures for PET, and Medicare could not immediately provide data on how much it has spent so far on the test for the nine cancers.
Metabolic activity
Patients given PET scans are injected with radioactive sugars that collect in parts of the body that are metabolically active and growing, such as a cancer.
This ability to detect biologically active parts of the body is a key difference between PET and CT scans, that use X-rays, or MRI scans, that use a magnetic field. While PET can find some cancers that CT and MRI miss, the images can show less detail or lead to false positives.
There was wide disagreement about the usefulness of PET when Medicare called for the registry three years ago, said Louis Jacques, director of Medicare's Division of Items and Devices Coverage and Analysis Group.
"Frankly, were were disappointed at how poor the evidence was," he said. Part of the problem is that various tumors behave differently, he said.
"Cancer really is a whole lot of different conditions," he added. "A blocked coronary artery is a blocked coronary artery. There aren't the five million different flavors that there are with cancer."
At the Aug. 20 meeting, Medicare officials will ask the panel whether the collected data shows doctors can better diagnose and monitor patients with the nine cancers. They will also ask whether the information could apply to other cancers.
Groups maintaining the registry, which also include the American College of Radiology Imaging Network and the American College of Radiology, have collected data for two years.
"As we look at each of the cancers, we have enough data to make good definitive statements on how the PET scans have altered the treatment of these patients," said Coleman, a GE Healthcare consultant and Duke University radiologist.
But some consumer advocates want the registry to continue and say more PET scan data is needed.
"We need better information on how these technologies are being used in the real world," said Merrill Goozner, director of the Center for Science in the Public Interest's Integrity in Science project.
(Editing by Tim Dobbyn)
