More Colonoscopy, More Early Detection
After Medicare Started Paying, More Got Colonoscopy and More Early Cancers Found
Dec. 19, 2006 -- Colonoscopy is catching on, improving patients' odds of
detection earlier, when colon cancer is usually more
That news comes from researchers at Yale University's medical school,
including Cary Gross, MD.
They found a rise in colonoscopy screening and earlier colon cancer
detection in people after Medicarestarted covering
In colonoscopy, doctors guide a thin, flexible tube with a tiny camera
through the patient's colon to check for abnormalities, including cancer and
is the third most common cancer among U.S. men and women (not
counting skin cancer), according
to the National Cancer Institute.
With about 60,000 new cases of colon cancer every year among those 65 and
older, even a 4% rise in early diagnosis can have an impact, Gross' team
The new study, published in The Journal of the American Medical
Association, is a snapshot of colonoscopy use in Medicare patients.
Medicare didn't cover colonoscopy from 1992 to 1997. From 1998 to 2001,
Medicare offered limited coverage, expanding to universal coverage in 2001.
Gross' team studied data from all three periods.
More Medicare patients got a colonoscopy after coverage became available,
the study shows. That is, the Medicare colonoscopy rate was higher from 1998 to
2001 than from 1992 to 1997.
But the colonoscopy rate didn't change when Medicare expanded its limited
colonoscopy coverage to universal coverage.
The researchers also analyzed the Medicare records of nearly
45,000 people aged 67 and older diagnosed with colon cancer from 1992 to
They found that earlier detection became more common after Medicare covered
For instance, when Medicare didn't cover the procedure, the proportion of
patients diagnosed at an early stage was 22.5%.
That figure rose to 25.5% when Medicare offered limited colonoscopy coverage
and increased to 26.3% when it provided universal coverage, the study
Room for Improvement
The findings are "encouraging," even though Medicare's impact on
early detection was "modest," write Gross and colleagues.
Study after study has shown too few people get a colonoscopy -- or any other
screening for colon cancer -- and this study is no exception.
"The majority of patients are still being diagnosed with later-stage
disease," the researchers write.
Editorialist Arden Morris, MD, MPH, notes "it remains to be seen" if
the trend toward earlier detection will continue.
Morris works in Ann Arbor at the University of Michigan's division of
The National Cancer Institute recommends colorectal
cancer cancer screening for
everyone 50 and older.
People at high risk of colon cancer may need to start screening earlier.
Check with your doctor about when you should begin.
Besides colonoscopy, other screening methods include:
- Flexible sigmoidoscopy: Similar to colonoscopy, but covers a smaller
section of the colon.
- Fecal occult blood test: A lab test that checks for hidden blood in
- Double-contrast barium enema: X-ray of the colon, highlighted by liquid
- Digital rectal exam: Often part of a routine physical exam; doctor or nurse
inserts a lubricated, gloved finger into the rectum to feel for abnormal areas
in the lower part of the rectum.
Ask your doctor which test is appropriate for you.