Many Medicare Beneficiaries Not Receiving Colorectal Cancer Screening

Abstract

A recent study finds significant underuse of colorectal cancer screening procedures among Medicare beneficiaries. The study, published in the January 15, 2008 issue of Cancer, a peer-reviewed journal of the American Cancer Society, shows that only 25% of Medicare patients received recommended screening during the study period. Doctor Gregory Cooper, interim Chief of Gastroenterology at University Hospitals Case Medical Center, and Professor of Medicine at Case Western Reserve University (CWRU) and the Case Comprehensive Cancer Center in Cleveland, Ohio, and Tzuyung Doug Kou, also of CWRU, assessed a population-based sample of 153,469 cancer-free Medicare beneficiaries identified in 1998, the first year in which colorectal cancer screening was reimbursed under Medicare. The beneficiaries included 17,940 patients with ≥1 risk factors for cancer and 135,529 “average risk” individuals. Their analysis shows that between 1991 and 1997, before colorectal cancer screening was reimbursed under Medicare, screening was performed in 29.2% of the studied population. This includes 76.7% of the increased risk group, but only 22.9% of “average risk” patients. In the years between 1998 and 2004, after screening was covered by Medicare, only about 1 in 4 beneficiaries (25.4%) received guideline-based follow-up screening. These included colonoscopy (17.6%), flexible sigmoidoscopy (2.9%), yearly fecal occult blood testing (0.8%), barium enema (0.1%), and >1 of these methods (4.1%). Subsequent screening was strongly associated with receipt of previous screening (35.7% vs 21.2% of others; P < .001), and was also more frequent in younger and Caucasian patients. These differences were maintained in multivariate analyses. Screening was more commonly performed in younger individuals, Caucasians, men, and residents of areas with higher income and educational levels. The study also found that compared with those who were never screened, patients who were screened between 1991 and 1997 were significantly more likely to receive subsequent screening between 1998 and 2004. The investigators note that the low overall screening rates are consistent with previous studies, and that a majority of Medicare beneficiaries received incomplete or no colorectal cancer screening. “Given the ability of screening tests to reduce cancer incidence and mortality, continued efforts to promote screening are clearly warranted,” they conclude. See “Underuse of Colorectal Cancer Screening in a Cohort of Medicare Beneficiaries.” Cancer. 2008;12:293–299.