Contact: Malaika Hilliard 202/973-5896 [email protected]
Sharon Burns-Pavlovsky 202/973-2934[email protected]
Elderly Adults Benefit from Screening Colonoscopy But millions of Medicare recipients unaware of coverage
LAS VEGAS (October 22, 2001) -- Researchers at the Cleveland Clinic Foundation found that the prevalence of neoplasia among elderly patients underscored the need for colonoscopy. A related study shows that although older adults who are Medicare beneficiaries are eligible for colorectal cancer screening tests, many are not aware of the benefit. The results of both studies were presented at the 66th Annual Scientific Meeting of the American College of Gastroenterology.
"Colorectal cancer screening tests detect cancer and polyps before symptoms develop," said Carol A. Burke, M.D., FACG, of the Department of Gastroenterology at the Cleveland Clinic Foundation. "Most cases of colorectal cancer are diagnosed after age 50, and that's why beginning at age 50, men and women without symptoms of colorectal cancer should have a fecal occult blood test (FOBT), flexible sigmoidoscopy, or colonoscopy."
If the patient has a personal history of colorectal cancer or precancerous polyps, or a family history of these conditions, they should begin screening earlier than age 50.
The Cleveland Clinic Foundation study was designed to determine the age when screening colonoscopies are no longer useful. Dr. Burke and lead study author Tyler Stevens, also of the Cleveland Clinic Foundation, analyzed records of 981 colonoscopies performed in their institution between 1997 and 2000. Of these, 52 percent were screening colonoscopies and 48 percent were performed to evaluate symptoms, such as abdominal pain or changes in bowel habits. More than one-third (37 percent) of the colonoscopies were performed on patients between the ages of 50 and 60, 28 percent were on patients between 61 and 70, 30 percent were on patients between 71 and 80, and five percent were on patients between 81 and 100.
"In our study, the prevalence of overall neoplasia peaked at age 70 and declined thereafter, however the risk of advanced adenomas, numerous polyps and invasive cancer continued to rise with age. Therefore it is not justified to halt screening in healthy, elderly patients," said Stevens.
Public Education About Benefits NeededEdward C. Mansley, Ph.D., of Merck & Co. of West Point, PA and colleagues conducted a random-digit-dial telephone survey of 502 U.S. residents at least 50 years old. Of these survey participants, 204 reported having Medicare insurance.
"More than 16 percent stated that they did not know whether FOBT was covered," said Dr. Mansley. "When we extrapolate that proportion to the Medicare population of 39.2 million, we estimate that 6.3 million Americans are unaware of their coverage. This study suggests that public education may be needed to increase awareness of coverage for colorectal cancer screening."
For Medicare recipients without symptoms or history of colon cancer, Medicare will cover FOBT every year, flexible sigmoidoscopy every four years, and (as of July 1, 2001) a colonoscopy once every 10 years. For people at high risk of colorectal cancer, Medicare covers a colonoscopy every two years.
"In addition to the 16 percent who did not know whether FOBT was covered, we found that another 12 percent believed they did not have this coverage. That proportion is more than double what we expected. Since 94.6 percent of Medicare beneficiaries have coverage for FOBT under Part B of the Medicare plan, we expected only 5.4 percent of the beneficiaries to say that they were not eligible for annual FOBT," said Mansley. "In addition, many survey participants were either unaware of their coverage or had inaccurate knowledge about coverage for sigmoidoscopy, and colonoscopy. We believe that screening rates for colorectal cancer may improve if awareness of insurance coverage increases."
The American Cancer Society estimates that more than 130,200 cases of colorectal cancer will be diagnosed this year in the United States, and more than 56,300 deaths will be attributed to this disease. Scientists have credited screening and polyp removal with the recent decline in colorectal cancer incidence and mortality rates during the mid-1990s.
The ACG was formed in 1932 to advance the scientific study and medical treatment of disorders of the gastrointestinal (GI) tract. The College promotes the highest standards in medical education and is guided by its commitment to meeting the needs of clinical gastroenterology practitioners. Consumers can get more information on GI diseases through the following ACG-sponsored programs:
* 1-800-978-7666 (free brochures on common GI disorders, including ulcer, colon cancer, gallstones, and liver disease)* 1-800-HRT-BURN (free brochure and video on heartburn and GERD)* www.acg.gi.org (ACG's Web site)
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