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.