October 21, 2020 — The number of screening CT colonography (CTC) exams appears to decrease after age 65 — a trend that may have a disproportionate impact on Black patients and those of other racial minorities, according to a study published October 18 in the Journal of the American College of Radiology.
The reason for the rate decrease could be due in part to a lack of Medicare coverage, wrote a team led by Dr. Courtney Moreno of Emory University School of Medicine in Atlanta.
“We observed that the relative utilization of screening CTC in individuals typically eligible for Medicare coverage decreased after age 65, suggesting access barriers related to a more restrictive Medicare coverage policy,” the team noted.
Colorectal cancer is the second leading cause of cancer death in the U.S., even though it is preventable with screening, the team wrote. Yet in 2009, the U.S. Centers for Medicare and Medicaid Services (CMS) stated that evidence for CTC is inadequate for colorectal cancer screening, although it covers other forms of colon cancer screening.
Does the CMS position negatively affect patients? Moreno’s group investigated this question via a study that evaluated the use of CTC by age and explored whether there was an association between its use and Medicare-eligible patients by race. The team used the American College of Radiology’s (ACR) CTC registry and included 12,648 screening exams.
The authors found a spike in screening for colon cancer at the age of 50, and an average yearly increase in the rate of 5.3% in patients between ages 52 and 64. But after the age of 65, the rate of CTC screening began to fall, decreasing by 6.9% per additional year of age above 65. They also found that among whites, the highest rate of CTC screening occurred between the ages of 65 and 69, while among Blacks, the highest rate occurred between the ages of 55 to 59.
The fact that CTC isn’t covered by Medicare after age 65 could be having a disparate effect on patients who can’t afford out-of-pocket charges: Citing healthcare cost estimator Costhelper.com, the authors noted that patients for whom CTC isn’t covered paid an average of $2,400 for CTC.
“The factors contributing to this disparity are likely social and structural,” the team wrote. “For example, median per person yearly income is lower for Black Medicare beneficiaries … compared with white Medicare beneficiaries … and average savings are also lower for Black Medicare beneficiaries compared with [white ones] … suggesting that [Black patients] may be less able to afford an out of pocket expense for screening CTC.”
CTC should be covered by Medicare for patients over 65, the authors wrote.
“Medicare coverage of screening CTC is needed so that Medicare patients who cannot afford to pay for this test out of pocket can undergo screening CTC,” they concluded.