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Medicare News
Medicare Colon Cancer Screening Misses Many
Minorities, Poor, Less Educated
Older patients also less likely to be screened
Feb. 13, 2007 The expanded Medicare coverage for
colorectal cancer screening has made this critical testing equally
available to all senior citizens, but, like is often the case in disease
screening, minorities, the poor and the less educated are less likely to
be screened. And, somewhat surprising, the study found women less likely
to get a colonoscopy.
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The report in the February 12, 2007 issue of the
Archives of Internal Medicine, one of the JAMA/Archives journals, says
there are significant disparities in screening practices by ethnicity,
sex, age, education and income level.
Colorectal cancer is the third most common cancer
affecting men and women in the United States with approximately 145,290
new cases in 2005. There is evidence that screening for colorectal
cancer decreases incidence and mortality from the disease, the authors
write.
Ashwin N. Ananthakrishnan, M.D., M.P.H., and
colleagues at Medical College of Wisconsin, Milwaukee, examined the
Medicare physician billing claims file for New York, Florida and
Illinois for 2002 and 2003 to identify the rates of colon cancer
screening tests in the population at average risk for the disease.
Data from the U.S. Census and the Medicare database
were used to verify the sex, race or ethnicity, age and social
characteristics of the population, such as the educational achievement
and per capita income level of each patient based on their ZIP codes of
residence. The type of test screening completed by each patient (fecal
occult blood test [FOBT], flexible sigmoidoscopy, double contrast barium
enema [DCBE] and colonoscopy) was also noted.
A total of 596,470 Medicare recipients were
included in the study population with an approximately even number of
patients in each age category (65 to 69, 70 to 74, 75 to 79, and 80 or
older) and more women than men in all three states.
The population was 89.5 percent white, 7 percent
African American and 2.1 percent Hispanic.
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More than 95% of US residents 65 years or older receive
inpatient and outpatient health services through
Medicare. Beginning on January 1, 1998, Medicare
began reimbursement for colon cancer screening for
persons at average risk with an annual
fecal occult blood testing,
flexible sigmoidoscopy, or DCBE. Beginning on July 1,
2001, Medicare coverage was expanded to cover
screening colonoscopy every 10 years for individuals
at average risk.
Latest
information, click below.
Medicare Preventive Care Benefits - Click |
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Highlights of the findings
● An estimated 18.3 percent of the sample
population had been screened for colon cancer during the study period.
● Fecal occult blood testing and colonoscopy were
the most common tests, accounting for 53.7% and 42.1%, respectively, of
all colorectal screening tests.
● Colonoscopy was used more commonly than the
other screening tests among men, younger age groups, and nonwhite
patients.
●
Younger women were as likely as, or more
likely, than men to undergo any screening test.
● An equal percentage of men and women underwent
colon cancer screening tests, but women were less likely to undergo a
colonoscopy.
● Higher income level was associated with
screening colonoscopy in white patients but not in nonwhite patients.
● Beneficiaries older than 80
years were less likely to undergo any screening test compared
with those aged 65 to 69 years
● A larger percentage of the population had
undergone a screening colon test in Florida (21.5 percent) compared with
Illinois (16.6 percent) and New York (16.2 percent) These were the only
three states tested.
● Blacks (9.7 percent) and Hispanics (8.1
percent) had lower rates of colon cancer screening compared with whites
(19.3 percent).
● Individuals living in ZIP codes with a higher
per capita income were more likely to undergo a colon screening test
than were those living in ZIP codes with a lower per capita income (21
percent and 14.6 percent in the highest and lowest tertiles
respectively).
● Women were less likely to undergo an invasive
screening test or colonoscopy.
● Residing in a ZIP code with a greater amount of
high school graduates was associated with undergoing colon cancer
screening.
Despite expanded Medicare coverage, there are
still significant disparities in colorectal cancer screening practices,
the authors conclude. Further research is needed to determine the basis
for the observed ongoing disparities to develop interventions to reduce
and eliminate these differences.
Editor's Note: This study was supported in part by
a grant from the National Institutes of Health.
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