Two former surgeon generals are pushing back on a CMS proposal aimed at expanding Medicare coverage of some colorectal cancer screening tests, The Center Square reported May 5.
The proposed rule would allow for coverage of non-invasive, blood-based tests under new national standards if they meet specific performance thresholds. But former surgeon generals Richard Carmona, MD, and Jerome Adams, MD, said the proposal risks missing early warning signs of CRC and does not align with how screening reduces deaths.
“The proposed framework emphasizes performance thresholds focused primarily on cancer detection,” Dr. Adams said in a public comment. “While that is important, it risks underweighting the need for strong sensitivity to precancerous lesions. A standard that prioritizes convenience and cancer detection alone, without robust requirements for detecting advanced precancerous changes, may miss the full preventive potential of screening. It’s akin to a smoke detector that alerts only after flames are visible, rather than when smoke first appears.”
Amitabh Chak, MD, president of the American Society for Gastrointestinal Endoscopy, told The Center Square that the policy could result in weaker tests becoming the standard.
“We are deeply concerned that the proposed decision does not include performance thresholds for advanced precancerous lesions (APLs), despite well-established evidence,” Dr. Chak said. “Lower sensitivity increases the risk of missed cancers and missed opportunities for early intervention. Allowing tests with substantially lower sensitivity to meet coverage criteria may introduce screening options that provide inferior clinical outcomes.”
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