Most Medicare Recipients Ignore Colorectal Cancer Screening

Most Medicare Recipients Ignore Colorectal Cancer Screening
MONDAY, Dec. 10 (HealthDay News) -- The majority of Americans inMedicare aren't getting screened for colorectal cancer, a major killer,even though the screening is free, a new study finds.
In fact, the percentage of enrollees in Medicare, the federal healthinsurance program for older Americans, getting screening tests such ascolonoscopies has declined since the program began paying for them, thestudy said.
An assessment of 153,469 Medicare members identified in 1998 found that29.2 percent of them were screened for colorectal cancer between 1991 and1997, when Medicare began paying for screening tests. Only 25.4 werescreened between 1998 and 2004, after screening was covered by Medicare,the study found.
Failure to get those tests costs lives, said study author Dr. GregoryCooper, interim chief of gastroenterology at University Hospitals CaseMedical Center in Cleveland.
"We know that the survival curve is strongly related to the state atwhich the cancer is diagnosed," he said. "For the mostly fairly healthypeople in this cohort, early detection would bring a benefit."
Colorectal cancer is the third leading cause of cancer deaths in theUnited States. The American Cancer Society estimates that 147,000 newcases will be diagnosed in this country this year, with 57,000 deaths.
The new study, published online Dec. 10 in the journal Cancer,looked at a variety of screening tests. They included barium enemas,methods of detecting fecal blood, and colonoscopy, which is regarded asthe most definitive test. By detecting polyps before they becomemalignant, a colonoscopy can help prevent cancer. Colonoscopies arerecommended every 10 years for adults, starting at age 50.
The public, doctors and the Medicare system itself are all responsiblein different ways for failures to screen for colorectal cancer, said Dr.Otis W. Brawley, chief medical officer of the American Cancer Society.
"Many physicians do not have a preventive mindset as yet," Brawleysaid. "People go to the doctor overwhelmingly because they are hurt andhave a medical problem. No one goes to the doctor with a preventiveintention."
Medicare does allow for an initial patient visit with a new doctor,"but it is designed to be all discussion, not for physical examinations,"Brawley said. "During that discussion, they [patients] may be told thatthey have this benefit, but it is up to them to ask for it."
And there's something about colorectal cancer that makes people shyaway from discussing it, Brawley said.
"Prostate cancer screening has not been shown to save lives, and peopleask for it," he said. "Colon cancer screening has been shown to savelives, and people don't ask for it."
The ultimate responsibility lies with the patient, Cooper said. "If thephysician doesn't bring it up, often the patient has to remind them," hesaid.
The new study findings are troubling, in light of research published inthe Journal of the American Medical Association last December thatfound that since Medicare began paying for colon-cancer screenings, morepatients' tumors are being diagnosed at an early, more curable stage.
The new findings also don't reflect a federal report released in Marchthat found that national goals for colorectal cancer screenings are ontarget with the Healthy People 2010 initiative.