As the nation debates whether and how health insurance should be reformed, researchers at the University of Wisconsin School of Medicine and Public Health determined that people with a certain type of insurance policy were more likely to be screened for colorectal cancer.
People with policies that cover computerized tomography (CT) colonography for colorectal cancer screening are almost 50 percent more likely to get screened than those whose policies don’t cover the procedure, according to a new retrospective study by Dr. Maureen Smith, professor in the departments of population health sciences and family medicine.
The findings appeared online in the journal Radiology.
CT colonography, also known as virtual colonoscopy, uses CT imaging to provide fly-through views of the colon and is a less invasive option than conventional colonoscopy.
Colorectal cancer kills 50,000 people each year, despite the existence of screening methods that provide early detection and treatment of the disease.
The American Cancer Society recommends CT colonography as one of the screening tests that can find both pre-cancerous polyps and cancer in people age 50 or older, but insurers have been slow to cover it.
Meanwhile, screening adherence rates have stalled at about two-thirds of the people who need to be screened, according to Smith.
“CT colonography is a newer technology that can detect both pre-cancer and cancer, but because it’s relatively new it isn’t widely covered by insurance and isn’t covered by Medicare,” Smith said.
Smith and her colleagues recently examined whether changing insurance benefits to cover CT colonography for screening might help improve screening rates.
Using electronic health records, the researchers looked at overall colorectal cancer screening rates for 33,177 patients younger than age 65 who were eligible and due for such screening. About half of the people in the group were ultimately screened during the study period, and researchers compared screening rates between those with and without insurance coverage for CT colonography.
Data analysis showed that the people in the study who had insurance coverage for CT colonography had a 48 percent greater likelihood of being screened by any method compared with those who were due for screening but did not have coverage.
“Our study suggests that when people are offered a greater choice of screening tests for colorectal cancer, including CT colonography, they are more likely to complete screening to prevent colorectal cancer,” Smith said.
The study was primarily funded by a grant from the National Cancer Institute, but also included career development and other support from the UW Institute for Clinical and Translational Research (ICTR). A pilot study, funded by the ICTR Community-Academic Partnerships program, provided preliminary data for the National Cancer Institute-funded study.
Other funding and support included the American Cancer Society, the UW Carbone Cancer Center, the UW School of Medicine and Public Health’s Health Innovation Program, and Wisconsin Partnership Program.
The study findings represent another piece of the puzzle in getting people to follow screening recommendations — a particularly important challenge in groups that traditionally have lower screening rates, such as people in rural areas, racial/ethnic minorities and people with lower incomes, she said.
“Policymakers should consider additional options for screening and prevention of colorectal cancer,” Smith said. “CT colonography is potentially a powerful option, because there are people who will prefer it.”
Some insurers have begun increasing coverage to include CT colonography, according to Smith, but the lack of coverage by Medicare is unlikely to change soon.
“Locally, insurers have been open to including CT colonography in their coverage,” she said. “Nationally, any change will probably rely on Medicare’s decision-making process, which can take substantially more time.”