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Medicare Coverage of Colorectal Screening Helps Early Detection

More patients diagnosed at preliminary, highly treatable stage

TUESDAY, Dec. 19, 2006 (HealthDay News) -- Since Medicare began paying for colon-cancer screenings several years ago, more patients' tumors are being diagnosed at an early, more curable stage, a new study finds.

As a result, "the mortality rate should start to drop within a couple of years," said study lead author Dr. Cary P. Gross, an associate professor of medicine at Yale University School of Medicine.

"It is great news that a change in Medicare policy has been followed by an increase in the likelihood that patients will be diagnosed at an early stage in colon cancer," Gross said.

The findings are published in the Dec. 20 issue of the Journal of the American Medical Association.

Medicare began partial coverage of colon-cancer screening tests in 1998, initially limiting colonoscopy coverage to high-risk individuals. It began coverage of colonoscopy for all Medicare enrollees in 2001. Colonoscopy is the most effective screening method for colon cancer, in which the intestine is examined to detect tumors or growths that might become cancerous.

The study found that data from the U.S. Surveillance Epidemiology and End Results (SEER) files on Americans 67 years and older showed a clear difference in detection rates with the change in policy. From 1992 to 1997, 22.5 percent of colorectal cancer patients were diagnosed at an early stage. That figure rose to 25.5 percent from 1998-2001, when limited Medicare coverage began, and to 26.3 percent in 2001-2002, when coverage became universal.

"Colonoscopy has been widely acclaimed as perhaps the best cancer screening test available," Gross said. "It can not only detect cancer at an early, curable stage, but can also prevent development of cancer. We found that as reimbursement expanded, so did the use of screening colonoscopy."

That increase in screening was found in Medicare beneficiaries who did not have colon cancer, too. The use of colonoscopy among those people went up 6.5 times from the time there was no Medicare coverage to the time full coverage took effect, the study found.

Christy Schmidt, senior director of policy for the American Cancer Society, says the study offers a lesson for medical insurance programs other than Medicare. "The American Cancer Society has been saying that we already know what to do to make a difference in incidence and death caused by cancer," she said. "Access to insurance to cover this kind of screening is absolutely critical."

Yet some health insurers don't cover such screening, Schmidt said. "They think that the person might change companies, so the benefit might go to someone else down the road," she said. The cancer society recommends colorectal cancer screening starting at age 50, Schmidt said, and "it is really critical that we all get tested."

Something of a dissenting voice comes from Dr. Arden M. Morris, an associate professor of surgery at the University of Michigan specializing in colorectal cancer, who wrote an accompanying editorial in the journal that questions widespread use of colonoscopy on economic grounds.

"My perspective is that screening is good, and that screening covered by Medicare is also good," Morris said. "But my doubts stem from the fact that the proportion of early cancers diagnosed after Medicare coverage of colonoscopy began did not rise appreciably. In 1998, when coverage of noncolonoscopic screening began, it had a positive impact. Starting in 2001, when colonoscopy was covered, no additional early stage cancers were identified."

"We need to be smart," she said. "Coverage of screening is very important, but we have to be judicious about how we fund it. We need to identify people at highest risk. We have to be smart about how we apply coverage so we don't go broke."

In her editorial, Arden wrote that "providing screening colonoscopy to all is not realistic." Other screening methods, such as testing for blood in stools, are effective yet much less expensive, she said.

The American Cancer Society reports that, other than skin cancer, colorectal cancer is the third most common cancer affecting American men and women. The society estimates there will be about 106,680 new cases of colon cancer and 41,930 new cases of rectal cancer in 2006 in the United States. Combined, they will cause about 55,170 deaths.

More information

Learn more about colon cancer at the American Cancer Society.

SOURCES: Cary P. Gross, M.D., associate professor of medicine, Yale University School of Medicine, New Haven, Conn.; Christy Schmidt, senior director of policy, American Cancer Society, Washington, D.C.; Arden M. Morris, associate professor of surgery, University of Michigan, Ann Arbor; Dec. 20, 2006, Journal of the American Medical Association
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