Medicare consumers are underutilizing colorectal cancer screening, according to the authors of a National Cancer Institute study conducted after initiation of the Medicare colorectal cancer screening benefit.
The study, conducted in North and South Carolina, relied on data from a 2001 telephone survey of a random sample of 2,004 eligible Medicare consumers. The analysis was based on the 1,901 with no history of CRC (Am. J. Prev. Med. 2006;30:313–9).
The strongest predictors of adherence to Medicare-covered testing intervals were elevated CRC risk, having a checkup in the past year, and having a usual source of care. The influence of a physician's recommendation also was evident.
“Almost all of the Medicare consumers who had received CRC tests indicated that they had also received a physician recommendation, while only 7% who had never been tested reported receiving a recommendation,” said Carrie N. Klabunde, Ph.D., of the National Cancer Institute, and her associates.
Overall, 72% of Medicare consumers reported receiving a recommendation to have a CRC test. Of those who had never been tested, lack of knowledge or awareness of the need for CRC screening, followed by the physician's not ordering the test, were the most commonly cited reasons.
When asked about colonoscopy, half of those interviewed said they had never heard of it. Similarly, 62% had never heard of fecal occult blood testing and 63% had never heard of sigmoidoscopy.
“These results are especially concerning because over 90% of consumers reported having a usual source of health care, and nearly 90% had a routine or preventive health care visit in the past 12 months,” the authors said.
In a separate analysis, the investigators found that only 57% of whites and 39% of blacks reported adhering to current Medicare-covered testing intervals, and one-quarter of whites and nearly one-half of blacks had “never” been tested.
“Despite the increased risk for CRC due to age, and insurance coverage for screening and treatment through Medicare, almost half of enrollees are not current with CRC screening recommendations,” the authors said (Am. J. Prev. Med. 2006;30:320–6).
“Improving initial test use among African American Medicare consumers is a necessary step toward increased compliance with guideline-based testing,” they said.