Disparities in colon cancer screening seen in Medicare population
NEW YORK (Reuters Health) - Although Medicare coverage for colorectal cancer screening has increased in recent years, there are still significant gender and racial gaps in screening uptake, new research shows.
In 2001, Medicare coverage for colon cancer screening 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 coverage began.
As reported in the Archives of Internal Medicine for February 12, 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, and Illinois in 2002 and 2003.
Approximately 18.3% of these subjects underwent a colon screening test during this period. The investigators found that nonwhite persons were 48% less likely to undergo colon cancer screening than their white counterparts. Specifically, "Blacks (9.7%) and Hispanics (8.1%) had lower rates of colon cancer screening compared with whites (19.3%)."
Age was also a factor in screening rates. "Almost 22% of individuals aged 65 to 69 years had undergone a screening test, compared with only 11.7% in the population older than 80 years."
In addition, a gender-based disparity in colon cancer screening was noted. For example, in subjects 80 years of age and older in the highest income tertile, women were 36% less likely to be screened than men.
A higher income level increased the odds of screening in white patients, but 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."
Arch Intern Med 2007;167:258-264.