Screening for Colorectal Cancer in Younger People Could
Save Millions for Medicare
May be example of how national health
plan could return some savings in Medicare; two other st
udies find
new technologies improve detection of polyps
Oct.
6, 2008 - The idea of a national health plan, now being debated in the
presidential election, is primarily seen as added government cost, but a
recent study indicates there may also be millions of dollars in savings
to the existing government health insurance program for senior citizens
– Medicare. A new study finds a screening program for colon cancer in
patients starting ten years prior to Medicare eligibility, at age 55
instead of Medicare’s 65, would save at least two dollars for every
dollar spent.
As people get older, their risk of developing
polyps and colorectal cancer increases. Current guidelines recommend a
screening colonoscopy for average risk individuals beginning at age 50.
But for many uninsured Americans, a lack of health
insurance coverage poses a barrier to screening. Medicare coverage for
most Americans begins at age 65, creating a coverage gap.
In order to determine the effect of a lack of
health coverage on screening and the cost effectiveness of screening
uninsured patients, Dr. Scott Tenner and colleagues from the State
University of New York and New York College of Osteopathic Medicine
offered free colonoscopies to 248 consecutive patients (mean age 55) at
Maimonides Medical Center in Brooklyn as part of a colorectal cancer
screening program.
Nearly 45 percent of patients had polyps.
Five patients had early stage colon cancer, and 22
patients had polyps larger than 1 cm. These large polyps are felt to
have a greater risk of harboring or developing into colorectal cancer
than smaller polyps.
The screening program cost a total of $390,000.
The researchers concluded that had these patients
not been screened, and the cancers and polyps allowed to progress
undetected - assuming the cost of treatment and screening would be
delayed until the Medicare eligibility age of 65 - the estimated costs
would be $1,295,000.
“Our study highlights the cost effectiveness and
the lifesaving potential of a federally funded screening program for the
uninsured ten years before they are eligible for Medicare,” said Dr.
Tenner, in a presentation at the American College of Gastroenterology’s
73rd Annual Scientific Meeting in Orlando.
Most polyps are not dangerous. Most are benign, which
means they are not
cancer. But over time, some types of polyps can turn into
cancer. Usually, polyps that are smaller than a pea aren't
harmful. But larger polyps could someday become cancer or may
already be cancer. To be safe, doctors remove all polyps and
test them.
New Screening Technologies Improve Detection of Polyps During
Colonoscopy
Two other studies presented at the American College of
Gastroenterology’s 73rd Annual Scientific Meeting in Orlando highlight
new technologies with the potential to improve the detection of
colorectal polyps and flat lesions during colonoscopy.
The American College of Gastroenterology endorses colonoscopy as the
preferred strategy for colorectal cancer screening because of its
remarkable sensitivity in detecting and removing polyps before they
become cancerous.
In a prospective study of 214 patients conducted at eight medical
institutions in the United States, Dr. Douglas K. Rex of Indiana
University Medical Center in Indianapolis, Dr. Jerome D. Waye of Mount
Sinai Hospital in New York, and their research team evaluated the
effectiveness of a new imaging device (Third Eye Retroscope ™) that
provides a 180-degree retrograde view of the colon, while complementing
the forward view of the standard colonoscope.
Researchers found that the retroscope, when combined with the standard
colonoscope, significantly increased the detection of adenomas and other
polyps. The retroscope detected 13.3 percent additional polyps and 12.4
percent additional adenomas. All polyps were removed by standard
colonoscope.
In a separate analysis conducted at Valduce Hospital in Como, Italy, Dr.
Franco Radaelli and his colleagues evaluated whether the use of narrow
band imaging (NBI) versus white light during the withdrawal phase of
colonoscopy could enhance the detection of flat or depressed colorectal
lesions.
Two hundred fifteen patients, ages 50 to 69, who had a positive fecal
occult blood test, underwent screening colonoscopy. Researchers found
narrow band imaging significantly improved the detection of flat or
depressed lesions, but did not increase the adenoma detection rate.
Twelve percent of patients with at least one flat or depressed lesion
were detected by white light, compared to 23 percent using narrow band
imaging.
About Colorectal Cancer Screening
Colorectal cancer is the second leading cause of
cancer deaths in the United States, second only to lung cancer. The ACG
recommends that for average-risk individuals, colorectal cancer
screening tests begin at age 50. African Americans should begin
screening at age 45. The preferred approach is a screening colonoscopy
every 10 years. For high-risk individuals, screening colonoscopy may
begin earlier and is performed more frequently.
About the American College of Gastroenterology
Founded in 1932, the American College of
Gastroenterology (ACG) is an organization with an international
membership of more than 10,000 individuals from 80 countries. The
College is committed to serving the clinically oriented digestive
disease specialist through its emphasis on scholarly practice, teaching
and research. The mission of the College is to serve the evolving needs
of physicians in the delivery of high quality, scientifically sound,
humanistic, ethical, and cost-effective health care to gastroenterology
patients.
The ACG is committed to providing accurate,
unbiased and up-to-date health information. Visit the ACG Web site
http://www.acg.gi.org to access educational resources for patients
and their families spanning the broad range of digestive diseases and
conditions - both common and not-so-common. Organized by disease, state
and organ system, these educational materials, developed by ACG
physician experts, are offered for the information and benefit of
patients and the public.
Keep up with the latest news for senior citizens, baby
boomers
Oct.
6, 2008 - The idea of a national health plan, now being debated in the
presidential election, is primarily seen as added government cost, but a
recent study indicates there may also be millions of dollars in savings
to the existing government health insurance program for senior citizens
– Medicare. A new study finds a screening program for colon cancer in
patients starting ten years prior to Medicare eligibility, at age 55
instead of Medicare’s 65, would save at least two dollars for every
dollar spent. 
