Most Medicare Recipients Ignore Colorectal Cancer Screening
MONDAY Dec. 10, 2007 -- The majority of Americans in Medicare aren't getting screened for colorectal cancer, a major killer, even though the screening is free, a new study finds.
In fact, the percentage of enrollees in Medicare, the federal health insurance program for older Americans, getting screening tests such as colonoscopies has declined since the program began paying for them, the study said.
An assessment of 153,469 Medicare members identified in 1998 found that 29.2 percent of them were screened for colorectal cancer between 1991 and 1997, when Medicare began paying for screening tests. Only 25.4 were screened between 1998 and 2004, after screening was covered by Medicare, the study found.
Failure to get those tests costs lives, said study author Dr. Gregory Cooper, interim chief of gastroenterology at University Hospitals Case Medical Center in Cleveland.
"We know that the survival curve is strongly related to the state at which the cancer is diagnosed," he said. "For the mostly fairly healthy people in this cohort, early detection would bring a benefit."
Colorectal cancer is the third leading cause of cancer deaths in the United States. The American Cancer Society estimates that 147,000 new cases will be diagnosed in this country this year, with 57,000 deaths.
The new study, published online Dec. 10 in the journal Cancer, looked at a variety of screening tests. They included barium enemas, methods of detecting fecal blood, and colonoscopy, which is regarded as the most definitive test. By detecting polyps before they become malignant, a colonoscopy can help prevent cancer. Colonoscopies are recommended every 10 years for adults, starting at age 50.
The public, doctors and the Medicare system itself are all responsible in different ways for failures to screen for colorectal cancer, said Dr. Otis W. Brawley, chief medical officer of the American Cancer Society.
"Many physicians do not have a preventive mindset as yet," Brawley said. "People go to the doctor overwhelmingly because they are hurt and have a medical problem. No one goes to the doctor with a preventive intention."
Medicare does allow for an initial patient visit with a new doctor, "but it is designed to be all discussion, not for physical examinations," Brawley said. "During that discussion, they [patients] may be told that they have this benefit, but it is up to them to ask for it."
And there's something about colorectal cancer that makes people shy away from discussing it, Brawley said.
"Prostate cancer screening has not been shown to save lives, and people ask for it," he said. "Colon cancer screening has been shown to save lives, and people don't ask for it."
The ultimate responsibility lies with the patient, Cooper said. "If the physician doesn't bring it up, often the patient has to remind them," he said.
The new study findings are troubling, in light of research published in the Journal of the American Medical Association last December that found that since Medicare began paying for colon-cancer screenings, more patients' tumors are being diagnosed at an early, more curable stage.
The new findings also don't reflect a federal report released in March that found that national goals for colorectal cancer screenings are on target with the Healthy People 2010 initiative.
Colorectal cancer screening is explained by the U.S. National Cancer Institute.
Posted: December 2007
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