Writing in the Philadelphia Inquirer about a loophole in the Affordable Care Act which disadvantages those who need colorectal cancer screening most, PRC Researcher Chyke A. Doubeni, MD, suggests that “this unfortunate scenario occurs in part because the U.S. Congress unfairly limits the ability of low-income Medicare beneficiaries to receive screening. This compounds other barriers and perpetuates long-standing disparities in mortality from colon cancer for seniors.”
Doubeni notes that misclassifiying colonoscopy as a “one-time activity” rather than including it in the screening menu of “a series of clinical activities involved in identifying and testing patients and performing diagnostic confirmation when necessary” makes the test available only to Medicare patients who can afford supplemental policies.
In the May 2016 issue of Gastroenterology, UPenn PRC Researcher Chyke Doubeni examines the barriers to screenings which provide early identification and prevention of colorectal cancer for low-income patients. Colorectal cancer is the second leading cause of cancer death in the United States; about 70% of those deaths occur in Medicare age-eligible patients.
Doubeni reviews the Affordable Care Act provisions intended to benefit low-income patients and examines why providers’ interpretations of those benefits have lead to confusion about insurance status of patients, insurance coverage for different steps of screening procedures, and reimbursement expectations. Doubeni’s recommendations include Congressional action to amend and clarify the provisions.
UPenn PRC’s Chyke Doubeni (pictured) recommends assessing risk and change over time when determining colorectal cancer screening guidelines.
In a recent editorial in the journal Gastroenterology, Chyke A. Doubeni, MD, MPH, Chair of the Department of Family Medicine and Community Health at the Perelman School of Medicine and a PRC researcher, and Robert H. Fletcher, MD of Harvard Medical School, call for a reassessment of colorectal cancer screening guidelines.
“The accumulated evidence shows that the risk of a colorectal cancer diagnosis in patients associated with having a family history of the condition becomes progressively smaller with increasing age, as does the association between family history and death from colorectal cancer,” Doubeni said. “Current standards recommend aggressive screening until age 75 to 85, but now a growing body of evidence show that it is not necessary to continue to screen most older people with a family history that aggressively.”
In light of these findings, for patients over 55—particularly those 65 years and older—who have only one immediate family member with colorectal cancer, Doubeni advocates for screening as recommended for average risk individuals (colonoscopy every ten years or other recommended screening test such as fecal immunochemical test every year). Those with two or more first-degree relatives with the disease, he says, should continue to receive a colonoscopy more often until more evidence is available.