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Study yields cancer screening surprise

Before 1992, there was no Medicare coverage for colorectal cancer screening. In 1998, Medicare's reimbursement policy changed to cover colonoscopy for those who were thought to be at increased risk for colon cancer. In 2001, coverage was enhanced to pay for screening colonoscopy for all regardless of risk.

By DR. V. UPENDER RAO
Published December 25, 2006

Researchers from the Robert Wood Johnson Clinical Scholars Program and Yale Medical School examined the impact of Medicare coverage for screening colonoscopy and the number of early cancers detected in a curable stage.

They designated the time before Medicare coverage for screening colonoscopy as Period I (before 1992); when coverage was available for those who were thought to be at increased risk as Period II (1992 to 1998); and when coverage was extended to all individuals regardless of risk as Period III (2001 onward).

They found that the number of colonoscopy screenings increased from an average of 285 per 100,000 per quarter in Period I to 889 and 1,919 per 100,000 per quarter in Periods II and III, respectively.

There was a strong association between the increasing number of screening colonoscopies and the detection of early stage cancers in the right side of the colon. There was, however, no such association of early cancer detection in the left or more distal part of the colon.

The results of this study were published in the Dec. 20 issue of the Journal of the American Medical Association.

The authors attributed the increased yield of early stage right-sided cancers to colonoscopy. This is, of course, because the colonoscope is longer and can reach the right colon and the shorter sigmoidoscope cannot.

They also point out that older people tend to have more right-sided cancers. The extended coverage for all individuals also captures those patients who are symptomatic, because the right-sided cancers tend to cause fewer symptoms than those of the left side.

This study also evaluated the yield of early stage cancers in the HMO population as compared to the Medicare recipients, who form a fee-for-service base.

The benefit seen in the Medicare population was consistently absent for the HMO patients in all three periods.

The authors suggest that the benefit for Medicare patients was directly related to the change in coverage rather than a national secular trend in clinical care. Lack of benefit for HMO patients was therefore likely due to lack of coverage.

The increased coverage to include all Medicare recipients is obviously helping detect early cancer at a more curable stage.

Considering that there are about 60,000 cases of colorectal cancer diagnosed each year, a 4 percent increase in early stage, curable cancer detection will have substantial impact at the population level.

V. Upender Rao, MD, FACP, practices at the Cancer and Blood Disease Center in Lecanto.

[Last modified December 24, 2006, 20:25:15]