Dually eligible and colorectal cancer screening: too little, too late?

Abstract

Background: Cancer screening reduces late-stage diagnosis. Medicare and Medicaid dually eligible patients receive more late stage colorectal cancer (CRC) diagnoses.

Methods: Characteristics of CRC patients diagnosed between 1997 and 2000 were extracted from the Michigan Tumor Registry and Medicare administrative data, Area Resource File, and U.S. Census to assess CRC screening (fecal occult blood testing (FOBT), barium enema, colonoscopy, and sigmoidoscopy) and late stage CRC diagnosis.

Results: Adjusted logistic regression models indicated dually eligible patients received less CRC screening (OR 0.68, 95% CI 0.59-0.78, p<.001). There was less late-stage diagnosis with colonoscopy receipt (OR 0.60, 95% CI 0.53-0.69, p<.001), sigmoidoscopy (OR 0.77, 95% CI 0.67-0.89, p<.001), and FOBT (OR 0.77, 95% CI 0.70-0.86, p<.01), but more if patients were dually eligible (OR 1.28, 95% CI=1.12-1.46, p<0.001).

Conclusions: Dually eligible CRC patients were screened less and diagnosed later than Medicare patients. Fecal occult blood testing remains a less invasive and less costly screening option that may reduce late-stage diagnosis in low income populations.