Many elders aren't screened for colon cancer

NEW YORK (Reuters Health) - Although Medicare coverage for colorectal cancer screening has increased in recent years, screening seems to be significantly underutilized by certain subgroups, which correlates with factors such as race and sex, new research shows.

In 2001, Medicare coverage for colon cancer screening was expanded to include colonoscopy every 10 years for people at average risk. While prior studies have documented disparities in screening rates between different groups, very few have examined these disparities since the expanded Medicare coverage began.

Colonscopy is currently the most accurate procedure available to examine the colon for high-risk polyps. It involves the insertion of a flexible tube into the colon allowing the physician to examine the bowel, which is projected upon a screen. The patient is usually lightly sedated during the procedure, which for most people is easy and painless.

Dr. Joan M. Neuner, from the Medical College of Wisconsin in Milwaukee, and colleagues analyzed data from 596,470 Medicare beneficiaries who submitted a billing claim in New York, Florida or Illinois in 2002 and 2003.

Approximately 18.3 percent of these subjects underwent a colon screening test during this period. The investigators found that nonwhites were 48 percent less likely to undergo colon cancer screening than their white counterparts. Specifically, "Blacks (9.7 percent) and Hispanics (8.1 percent) had lower rates of colon cancer screening compared with whites (19.3 percent)."

Age was also a factor in screening rates. "Almost 22 percent of individuals aged 65 to 69 years had undergone a screening test, compared with only 11.7 percent in the population older than 80 years," according to their study, which is published in the Archives of Internal Medicine.

In addition, a gender-based disparity in colon cancer screening was noted. For example, among patients 80 years of age or older who were in the highest income bracket, women were 36 percent less likely to be screened than men.

A higher income level also increased the odds of screening in white patients overall, but income had no significant effect in nonwhite patients, the report indicates.

"Further research is needed to determine the basis for the observed ongoing disparities to develop interventions to reduce and eliminate these differences," the authors state.

"Policy initiatives are necessary to increase the awareness of colorectal cancer screening, especially in women and in racial/ethnic minorities, and to increase physician awareness about screening."

SOURCE: Archives of Internal Medicine, February 12, 2007.