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Colorectal Cancer Identification Methods Among Kansas Medicare Beneficiaries, 2008–2010

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Colorectal Cancer Identification Methods Among Kansas Medicare Beneficiaries, 2008–2010

ORIGINAL RESEARCH — Volume 12 — July 9, 2015

Sue-Min Lai, PhD, MS, MBA; Jessica Jungk, MS, MPH; Sarma Garimella, MBBS, MPH

Suggested citation for this article: Lai S, Jungk J, Garimella S. Colorectal Cancer Identification Methods Among Kansas Medicare Beneficiaries, 2008–2010. Prev Chronic Dis 2015;12:140543. DOI:http://dx.doi.org/10.5888/pcd12.140543.

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On this Page

• Abstract
• Introduction
• Methods
• Results
• Discussion
• Acknowledgments
• Author Information
• References
• Tables

Abstract

Introduction

Population-based data are limited on how often colorectal cancer (CRC) is identified through screening or surveillance in asymptomatic patients versus diagnostic workup for symptoms. We developed a process for assessing CRC identification methods among Medicare-linked CRC cases from a population-based cancer registry to assess identification methods (screening/surveillance or diagnostic) among Kansas Medicare beneficiaries.

Methods

New CRC cases diagnosed from 2008 through 2010 were identified from the Kansas Cancer Registry and matched to Medicare enrollment and claims files. CRC cases were classified as diagnostic-identified versus screening/surveillance-identified using a claims-based algorithm for determining CRC test indication. Factors associated with screening/surveillance-identified CRC were analyzed using logistic regression.

Results

Nineteen percent of CRC cases among Kansas Medicare beneficiaries were screening/surveillance-identified while 81% were diagnostic-identified. Younger age at diagnosis (65 to 74 years) was the only factor associated with having screening/surveillance-identified CRC in multivariable analysis. No association between rural/urban residence and identification method was noted.

Conclusion

Combining administrative claims data with population-based registry records can offer novel insights into patterns of CRC test use and identification methods among people diagnosed with CRC. These techniques could also be extended to other screen-detectable cancers.

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Introduction

Colorectal cancer (CRC) is the third most common cancer and third leading cause of cancer death in Kansas (1). In 2002, the US Preventive Services Task Force (USPSTF) strongly recommended that people aged 50 years or older be screened for CRC on the basis of evidence that screening is effective in reducing CRC mortality rates (2,3). As a result of this recommendation, CRC screening has been widely promoted by many groups, including the National Cancer Institute, the Centers for Disease Control and Prevention (CDC), and the American Cancer Society (ACS). Use of CRC tests among US adults has been increasing (4–6). From 2000 to 2010, the percentage of US adults aged 50 to 75 receiving any CRC screening test within recommended intervals increased from 38.6% to 59.1% (4,7). At the same time, CRC incidence has been declining and the proportion of cases diagnosed at a localized stage has been increasing, trends attributed to a combination of risk-factor reduction and increased screening rates (8). However, CRC screening rates still lag behind those for other effective cancer screening tests. In 2010, less than half of CRC cases were diagnosed at a localized stage in both Kansas (41%) and the United States (39%) (1,7,9). Although CRC screening is promoted as a key tool for improving CRC outcomes, few data are available on how often CRC cases are identified through screening or surveillance in asymptomatic patients versus diagnostic workup for symptoms, particularly at the population level. Documenting trends in CRC identification methods could provide additional insight into the contributions of screening to CRC prevention and morbidity reduction. In addition, analyses of patient and tumor characteristics by identification method could identify population subgroups not benefiting from CRC screening and tumor subgroups not amenable to identification by screening. We sought to explore the circumstances leading to the identification of CRC, to examine relationships between identification method and patient and tumor characteristics, and to develop a process for assessing CRC identification methods among Medicare-linked CRC cases from a population-based cancer registry.

Acknowledgments

This project was supported by the Kansas Department of Health and Environment and the National Program of Cancer Registries from CDC agreement no. U58/DP003889.

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Author Information

Corresponding Author: Sue-Min Lai, PhD, MS, MBA, Kansas Cancer Registry, Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Mail Stop 1008, 3901 Rainbow Blvd, Kansas City, KS 66160-7313. Telephone: 913-588-2744. Email: slai@kumc.edu.

Author Affiliations: Jessica Jungk, Sarma Garimella, Kansas Cancer Registry, Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas.

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