Panel Urges Coverage for PET in Breast Cancer

WASHINGTON—A federal panel has recommended that the Centers for Medicare and Medicaid Services (CMS) cover the use of positron emission tomography (PET) as an adjunct to standard staging tests in detecting locoregional or distant metastases recurrence in some patients when results from other tests are inconclusive.

In doing so, the executive committee of the CMS Medicare Coverage Advisory Committee (MCAC) affirmed a series of decisions made by the MCAC’s diagnostic imaging panel about the use of PET in breast cancer patients. All but one of the imaging panel’s decisions were negative.

At its June 2001 meeting, the diagnostic imaging panel voted that inadequate evidence existed for improved health outcomes to support Medicare coverage of PET in breast cancer in five areas: (1) To decide whether to perform a biopsy in patients with an abnormal mammogram or palpable mass, (2) to detect breast cancer in patients with low-suspicion findings on mammography and other routine imaging procedures, (3) to decide whether to perform axillary node dissection, (4) to use as a replacement for or adjunct to standard staging tests in looking for locoregional or distant metastases recurrence, and (5) to evaluate tumor response to different chemotherapeutic agents.

Two New Studies

The imaging panel’s decision to support PET as an adjunct in patients with known or suspected recurrent breast cancer hinged on a re-evaluation of the data. At its meeting, the group received a technology assessment of the published literature, which found inadequate evidence to support PET for the diagnosis of recurrent breast cancer.

After an extensive discussion, the panel voted 5 to 0, with one abstention, to recommend PET coverage for that purpose.

When the executive committee met, Peter Conti, MD, of the University of Southern California, speaking on behalf of the Society of Nuclear Medicine and the American College of Radiology, urged ratification of the imaging panel’s decision on PET.

Dr. Conti also described a study of 50 women with breast cancer who had been referred for PET scans for restaging. The report was published in the September 4, 2001, issue of The Journal of Nuclear Medicine, a few months after the imaging panel meeting. In this study, which surveyed 32 physicians, "it was reported that a PET scan changed clinical management of 60% of women with recurrent breast cancer," Dr. Conti said. "It also changed the cancer staging of 36% of those scanned; 28% were upstaged and 8% were down-staged."