Strengthening colorectal cancer screening standards saves lives

OPINION:

Two years ago, I had a colonoscopy. I’m grateful I did. My doctor detected and removed precancerous polyps before they could progress. Because of that timely intervention, I avoided a cancer diagnosis altogether. I share this not for sympathy but rather because it highlights what is truly at stake in an important policy discussion underway at the Centers for Medicare & Medicaid Services, one that has received too little public attention but could affect millions of lives.

CMS has proposed updates to its coverage framework for noninvasive colorectal cancer screening tests under National Coverage Determination 210.3. As a physician and former surgeon general, I am concerned that the current proposal may not fully align with the established science on what makes screening most effective at preventing colorectal cancer.

The science is clear: The greatest long-term reduction in colorectal cancer mortality, more than 80% of the benefit, comes from detecting and removing precancerous lesions (such as advanced adenomas) before they develop into cancer. My own experience underscores this reality. Screening is most powerful when it interrupts the disease process early, not just when it identifies cancer after it has formed.

The proposed framework emphasizes performance thresholds focused primarily on cancer detection. Although 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 is akin to a smoke detector that alerts only after flames are visible rather than when smoke first appears.

I commend this administration’s commitment to improving health care efficiency, reducing Medicare waste and expanding access to innovative tools. Administrator Mehmet Oz has brought valuable energy and a fresh perspective to CMS, challenging long-standing approaches in ways that can benefit patients and taxpayers. Innovation is essential, but so is ensuring that covered tests meet evidence-based standards that truly advance prevention.

Preventing cancer is far more cost-effective than treating it. A coverage approach that guides patients toward tests strong in convenience but weaker in detecting precancerous lesions could ultimately increase long-term costs to Medicare, in both financial and human terms.

CMS has an opportunity here to set a strong, technology-neutral standard: Require that any covered noninvasive screening test demonstrate meaningful sensitivity to advanced precancerous lesions, not just to cancer itself. This would encourage the development of better tools while protecting patients.

To help ensure the final decision reflects the best available evidence, I encourage CMS to convene a Medicare Evidence Development & Coverage Advisory Committee. Bringing together clinical experts, researchers and patient advocates for a rigorous, transparent review would be a responsible step for a decision of this importance.

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During my time as surgeon general, I consistently urged Americans to be screened for colorectal cancer. I know, from both professional and personal experience, why that message is vital. CMS now has the chance to reinforce prevention with a coverage framework that fully supports it. I hope it will seize this opportunity to prioritize the science of early intervention and save lives.

• Dr. Jerome Adams served as the 20th surgeon general of the United States from 2017 to 2021.