No abstract

Expansion of Medicare reimbursement to cover colon cancer screening was associated with an increased use of colonoscopy for Medicare beneficiaries, and for those who were diagnosed with colon cancer, an increased probability of being diagnosed at an early stage. The selective effect of the coverage change on proximal colon lesions suggests that increased use of whole-colon screening modalities such as colonoscopy may have played a pivotal role.

BACKGROUND. The purpose of this study was to determine whether racial disparities in cancer therapy had diminished since the time they were initially documented in the early 1990s. METHODS. The authors identified a cohort of patients in the SEER‐Medicare linked database who were ages 66 to 85 years and who had a primary diagnosis of colorectal, breast, lung, or prostate cancer during 1992 through 2002. The authors identified 7 stage‐specific processes of cancer therapy by using Medicare claims. Candidate covariates in multivariate logistic regression included year, clinical, and sociodemographic characteristics, and physician access before cancer diagnosis. RESULTS. During the full study period, black patients were significantly less likely than white patients to receive therapy for cancers of the lung (surgical resection of early stage, 64.0% vs 78.5% for blacks and whites, respectively), breast (radiation after lumpectomy, 77.8% vs 85.8%), colon (adjuvant therapy for stage III, 52.1% vs 64.1%), and prostate (definitive therapy for early stage, 72.4% vs 77.2%, respectively). For both black and white patients, there was little or no improvement in the proportion of patients receiving therapy for most cancer therapies studied, and there was no decrease in the magnitude of any of these racial disparities between 1992 and 2002. Racial disparities persisted even after restricting the analysis to patients who had physician access before their diagnosis. CONCLUSIONS. There has been little improvement in either the overall proportion of Medicare beneficiaries receiving cancer therapies or the magnitude of racial disparity. Efforts in the last decade to mitigate cancer therapy disparities appear to have been unsuccessful. Cancer 2008. © 2008 American Cancer Society.