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Many Medicare beneficiaries not receiving
colorectal cancer screening.
A new 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, show that only 25 percent of
Medicare patients received recommended
screening during the study period.
Colorectal cancer is the third leading cause
of cancer death in both men and women in the
United States. The American Cancer Society
estimates that in 2007, more than 147,000
new cases will be diagnosed and more than
57,000 people will die from the disease.
Population-based screening for colorectal
cancer is currently recommended for adults
aged 50 and older. Regular colorectal cancer
screening can, in many cases, prevent
colorectal cancer altogether.
Gregory Cooper, MD, 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 one or more 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 percent of the studied
population. This includes 76.7 percent of
the increased risk group, but only 22.9
percent of “average risk” patients. In the
years between 1998 and 2004, after screening
was covered by Medicare, only about one in
four beneficiaries (25.4 percent) received
guideline-based follow-up screening.
Screening was more commonly performed in
younger individuals, in Caucasians, in men,
and in residents of areas with higher income
and educational level. They also found that
compared to 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.
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