Institutional members access full text with Ovid®

Share this article on:

Medicare Cancer Screening in the Context of Clinical Guidelines: 2000 to 2012

Maroongroge, Sean*,†; Yu, James, B.*,†,‡

American Journal of Clinical Oncology: April 2018 - Volume 41 - Issue 4 - p 339–347
doi: 10.1097/COC.0000000000000272
Original Articles: Screening

Objectives: Cancer screening is a ubiquitous and controversial public health issue, particularly in the elderly population. Despite extensive evidence-based guidelines for screening, it is unclear how cancer screening has changed in the Medicare population over time. We characterize trends in cancer screening for the most common cancer types in the Medicare fee-for-service (FFS) program in the context of conflicting guidelines from 2000 to 2012.

Materials and Methods: We performed a descriptive analysis of retrospective claims data from the Medicare FFS program based on billing codes. Our data include all claims for Medicare part B beneficiaries who received breast, colorectal (CRC), or prostate cancer screening from 2000 to 2012 based on billing codes. We utilize a Monte Carlo permutation method to detect changes in screening trends.

Results: In total, 231,416,732 screening tests were analyzed from 2000 to 2012, representing an average of 436.8 tests per 1000 beneficiaries per year. Mammography rates declined 7.4%, with digital mammography extensively replacing film. CRC cancer screening rates declined overall. As a percentage of all CRC screening tests, colonoscopy grew from 32% to 71%. Prostate screening rates increased 16% from 2000 to 2007, and then declined to 7% less than its 2000 rate by 2012.

Discussion: Both the aggressiveness of screening guidelines and screening rates for the Medicare FFS population peaked and then declined from 2000 to 2012. However, guideline publications did not consistently precede utilization trend shifts. Technology adoption, practical and financial concerns, and patient preferences may have also contributed to the observed trends. Further research should be performed on the impact of multiple, conflicting guidelines in cancer screening.

*Yale School of Medicine

Department of Therapeutic Radiology, Yale School of Medicine

Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT

J.B.Y. received research support from 21st Century Oncology. S.M. declares no conflicts of interest.

Reprints: James B. Yu, MD, MHS, Department of Therapeutic Radiology, Yale School of Medicine, HRT 138, 333 Cedar St., New Haven, CT 06520. E-mail: james.b.yu@yale.edu.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.