early diagnosis of colorectal cancer
When Medicare was expanded to cover screening for colorectal cancer, the percentage of patients diagnosed with the disease increased and the use of colonoscopy may have played a pivotal role, according to results of a study by Yale School of Medicine researchers in the Dec. 20 issue of Journal of the American Medical Association (JAMA).
Medicare reimbursement policy was changed in 1998 to provide coverage for screening colonoscopies of patients with increased colon cancer risk. The policy was expanded in 2001 to cover colonoscopy screenings for all individuals. The Yale team sought to determine whether the Medicare reimbursement policy changes were linked to an increase in either colonoscopy use or early-stage colon cancer diagnosis.
Led by Dr. Cary P. Gross, associate professor of medicine at the School of Medicine, the team evaluated patients in the Surveillance, Epidemiology and End Results (SEER) Medicare linked database who were 67 years of age and older and had a primary diagnosis of colon cancer between 1992 and 2002. The database also included a group of Medicare beneficiaries who resided in the SEER areas who were not diagnosed with cancer. The team evaluated trends in colonoscopy and sigmoidoscopy use among Medicare beneficiaries without cancer over the course of three time segments of the study.
During the study period, colonoscopy uses increased by 600% and 44,924 patients were diagnosed with colorectal cancer. The initiation of Medicare reimbursement was significantly related to both use of screening colonoscopy in patients without cancer, and the stage at diagnosis for patients found to have colon cancer.
In the time period prior to the new Medicare reimbursement policies (1992-1997), 22.5% of patients with colon cancer were diagnosed at an early stage. After the new Medicare policies were enacted, there was an increase in the percentage of patients who were diagnosed with early stage cancer. After the first policy change, (1998-2001), 25.5% of colon cancer patients were diagnosed at an early stage, and after the second policy change, (2001-02), among patients who were diagnosed with colon cancer, 26.3% were diagnosed at an early stage.
"We found that as the use of colonoscopy increased after the Medicare policy change, there was a corresponding increase in the likelihood that patients with colon cancer would be diagnosed at an early, curable stage," says Gross. "The increased use of whole-colon screening such as colonoscopy likely played a key role. These data strongly support initiatives to increase access to and use of screening colonoscopy."
The study was funded by a Beeson Career Development Award to Gross, and by the Claude D. Pepper Older Americans Independence Center at Yale.
Other authors on the study included Martin S. Anderson, Dr. Harlan M. Krumholz, Gail J. McAvay, Dr. Deborah Proctor and Dr. Mary E. Tinetti.
-- By Karen Peart
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