CDC Researcher Suggests Lack of Insurance is Reason
for Lack of Colorectal Cancer Screening
Rates of those tested jumped after 2001 when Medicare
expanded coverage for colonoscopy
While few people
will rank a colonoscopy as a favorite medical procedure, one
statistic argues clearly in its favor: a 90 percent cure rate in
colon cancers caught at an early stage.
Report from Temple University, School of Medicine.
When Benjamin Krevsky, MD gave
patients ear buds to listen to music during a colonoscopy, they
needed less sedation, yet reported the same levels of comfort as
those patients who needed more sedation. (Photo by Ryan
Brandenberg, University Photography)
July 14, 2008 There is new evidence today that
national health insurance will save millions of lives and many health
care dollars. This new study looked at Americans age 50 and older and
found just about half are taking the recommended screening tests for
colorectal cancer, despite massive evidence showing this can reduce
deaths from this deadly cancer. Lack of insurance coverage seems to be a
major factor.
The Centers for Disease Control and Prevention
conducted a National Health Interview Survey and found only 50 percent
of men and women 50 and older had received screening in 2005. Although
this was an improvement over the 43 percent of screened individuals
reported in 2000, it is still far from optimal, according to a report in
the July 2008 issue of Cancer Epidemiology, Biomarkers and Prevention, a
journal of the American Association for Cancer Research.
"Colorectal cancer is one of the leading cancer
killers in the United States, behind only lung cancer. Screening has
been shown to significantly reduce mortality from colorectal cancer, but
a lot of people are still not getting screened," said Jean A. Shapiro,
Ph.D., an epidemiologist at the Centers for Disease Control and
Prevention (CDC).
Shapiro says a major problem appears to be
insurance coverage.
Among people without health insurance, researchers
found the rate of colorectal cancer screening was 24.1 percent compared
to over 50 percent of insured Americans, depending on the type of
insurance.
Among patients without a usual source of health
care, the screening rate was 24.7 percent compared to 51.9 percent of
patients with a usual source of health care.
"If we can increase the number of people who have
health care coverage, we should be able to increase colorectal cancer
screening rates," said Shapiro.
Shapiro says the increase in colorectal cancer
screening rates observed from 2000 to 2005 may have been due in part to
increased media coverage of the importance of colonoscopy as a measure
to prevent cancer and detect it early, including a broadcast of Katie
Couric, then co-host of NBC's Today show, undergoing a colonoscopy.
American Cancer Society estimates over 147,000 new
cases and 57,000 deaths this year
Dec. 10, 2007
However, Shapiro adds, the increase was probably
also due to the fact that in 2001, Medicare expanded its coverage for
colonoscopy screenings to a wider range of patients.
"Health care access and insurance are important,"
Shapiro said.
Beyond health insurance, researchers at the CDC
reported the following factors influenced the use of colorectal cancer
screening tests:
● Education: 37 percent of people with
less than a high school education received screening vs. 60.7 percent of
college graduates.
● Household income: 37.4 percent of
people earning less than $20,000 in annual household income received
screening vs. 58.5 percent of people earning $75,000 or more.
● Frequency of physician contact: 19.5
percent of patients who had not seen a physician in the past year had
received screening vs. 52.5 percent of patients who had seen their
physician two to five times in the previous year.
Approximately 50 percent of patients who did not
receive testing said they had "never thought about it," while about 20
percent said their "doctor did not order it," researchers found.
"Many doctors are aware, but some may still need to
be educated about the importance of colorectal cancer screening," said
Shapiro.
These data were derived from the CDC's 2005
National Health Interview Survey which interviewed 30,873 adults in a
demographically representative sample of Americans. Interviews were
conducted in person with a 68 percent response rate. For the current
analysis, Shapiro and colleagues focused on 13,480 patients who were age
50 and older.
Editors Notes:
The mission of the American Association for Cancer
Research is to prevent and cure cancer. Founded in 1907, AACR is the
world's oldest and largest professional organization dedicated to
advancing cancer research. The membership includes more than 28,000
basic, translational and clinical researchers; health care
professionals; and cancer survivors and advocates in the United States
and 80 other countries. AACR marshals the full spectrum of expertise
from the cancer community to accelerate progress in the prevention,
diagnosis and treatment of cancer through high-quality scientific and
educational programs. It funds innovative, meritorious research grants.
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