Medicare beneficiaries who reside in affluent communities are nearly six times more likely to receive a CT colonography exam than others in low-income areas, according to a new analysis.

Optical colonoscopy is considered the gold standard when screening for the disease, which is the second leading cause of cancer deaths in the U.S. However, it also is the most invasive method, a fact that may deter some from sticking to the every-10-year recommendation, experts wrote Wednesday in the American Journal of Roentgenology.

Computed tomography-based screening, which does not require anesthesia, offers an alternative. Yet, despite the U.S. Preventive Services Task Force endorsing it as an option, Medicare continues refusing to provide reimbursement.

“It is unclear as to why CMS does not cover screening CT colonography as it does for all other guideline-recommended colorectal cancer screening strategies” co-author Judy Yee, MD, chair of radiology at Montefiore Health System in New York, said in a July 19 announcement of the study’s results. “Medicare coverage of screening CT colonography could lessen income-based access disparities as well as downstream colorectal cancer disparities since CTC can lead more individuals to be screened so that cancers are prevented completely or detected early.”

Supported by the Neiman Health Policy Institute, Yee and co-authors sought to better understand the ramifications of this coverage decision. They retrospectively analyzed CMS data spanning 2011 to 2020 using a nationally representative sample of 5% of Medicare fee-for-service beneficiaries. Subjects spanned ages 45 to 85, with modeling used to determine patients’ likelihood of undergoing the various cancer tests.

Extrapolated across all of Medicare, there were more than 785,000 colorectal cancer screening events during the study period, including 645 that used CT. Individuals living in communities with annual per-capita income greater than $100,000 were 5.7 times likelier to be screened using medical imaging when compared to others in areas at or below $25,000. They similarly had better chances of receiving optical colonoscopy and stool-based tests, though the gap was narrower. CTC utilization also was lower for those residing outside of metropolitan areas, the authors added.

“The inverse relationship between screening CTC use and income contrasts with the findings of prior research performed before Medicare clarified that it would not cover screening CTC,” the study concluded. “The findings indicate that lower income groups may prefer the less-invasive and accurate screening approach of CTC, absent a cost barrier. Thus, Medicare’s coverage determination may result in differences in screening adherence for lower-income beneficiaries.”

Read more from AJR at the link below.