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Colon Cancer being Diagnosed at Earlier Stage
Written by Jeanne Bohm, Ph.D.   

After Medicare increased the amount it reimburses for colon cancer screening in 1998, there has been an increase in colonoscopies as well as a greater number of patients being diagnosed with colon cancer at an early stage, according to a study in the December 20 issue of JAMA.

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Regular screening is the most effective way to detect colon cancer at an early stage, however widespread screening has been below optimal levels. Several studies suggest that lack of insurance coverage may be a barrier to colon cancer screening - and prior to 1998 Medicare did not routinely reimburse colon cancer screening.

Cary P. Gross, M.D., and colleagues from the Yale University School of Medicine, asked if the expanded Medicare reimbursement policies after 1998 changed the use of colonoscopy and early diagnosis among Medicare beneficiaries without cancer.

The Surveillance Epidemiology and End Results (SEER) database, a Medicare linked database of individuals who were 67 years of age and older, was reviewed for cancer cases and timeframe of diagnosis. Cancer patients had stages classified as early (stage I) vs. all other (stages II-IV). Time was categorized as period 1 (no screening coverage, 1992-1997), period 2 (limited coverage, January 1998-June 2001), and period 3 (universal coverage, July 2001-December 2002).

The researchers found that among Medicare beneficiaries without cancer there was an increase in colonoscopy use. The average colonoscopy rate per 100,000 beneficiaries per quarter tripled from period 1 to 2 and increased 6.5 times from period 1 to period 3.

Researchers also found that time period was significantly correlated to stage at diagnosis. Approximately 22.5 percent of patients were diagnosed at an early stage in period 1 (1992-1997) compared with 25.5 percent in period 2 and 26.3 percent in period 3. It was also found that patients diagnosed in periods 2 and 3 were significantly more likely to have early-stage illness than patients iagnosed in period 1.

The authors concluded that the new Medicare policies may facilitate early diagnosis and suggests other efforts be enacted to broaden increase use of screening tests in the older population. Based on the study results, they believe that increased use of screening tests has the potential to diagnose more beneficiaries at an early stage.


AMA / JAMA Media Release

Relation Between Medicare Screening Reimbursement and Stage at Diagnosis for Older Patients With Colon Cancer. JAMA. 2006;296:2815-2822.

About the Author

Jeanne Bohm, Ph.D. is a cancer biologist by training, a medical writer and an experienced science educator.

The author has no financial relationship to any of the companies listed in the article.

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