A new Harvey L. Neiman Health Policy Institute study found that Medicare fee-for-service beneficiaries who reside in communities with annual per capita income of $100,000 or more are 5.7 times more likely to receive CT colonography (CTC) than their counterparts residing in communities with per capita income of less than $25,000. 

This American Journal of Roentgenology study was based on a nationally representative sample of Medicare fee-for-service beneficiaries who received 785,103 colorectal cancer screening tests between 2011 and 2020. Medicare provides coverage for all guideline-recommended colorectal cancer screening strategies except for CT colonography. 

“Although higher income was also associated with a greater likelihood of screening by optical colonoscopy (36%) and stool-based tests (guaiac fecal-occult blood test/fecal immunochemical test, 50%, or stool-DNA, 43%), the association of income with test use was several orders of magnitude larger for CT colonography than it was for other Medicare-reimbursed colorectal cancer screening tests,” says Eric Christensen, PhD, research director at the Neiman Institute. “Medicare’s non-coverage for screening CT colonography may also contribute to income-based disparities in CT colonography use.”

What’s more, says Pina Sanelli, MD, MPH, FACR, Professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in Hempstead, N.Y., “Optical colonoscopy is often considered to be the gold standard for colorectal cancer screening, yet some individuals may be reluctant to undergo colonoscopy because of the test’s invasiveness, need for anesthesia, risk of complications, or time away from work. Hence, other guideline-recommended colorectal cancer screening tests are beneficial to the degree that they may expand the share of the eligible population who are screened.”

“Medicare coverage of screening CT colonography could potentially reduce income-based disparities for individuals avoiding optical colonoscopy due to invasiveness, need for anesthesia, complication risk, or time away from work,” Sanelli adds.

Judy Yee, MD, FACR, university chair of radiology at New York City-based Montefiore Health System and Albert Einstein College of Medicine, as well as professor of radiology at Einstein, also spoke out about this finding, stating: “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. Unlike stool-based tests, CTC is a structural test and can identify precursor polyps.”