Physicians at the root of Medicaid cancer screening delinquency

Only about half of Medicaid recipients age 50 and older appear to receive recommendations from their primary care physicians to undergo screening tests for colorectal, breast and cervical cancer, according to a report in the October 13 issue of Archives of Internal Medicine.

These three types of cancer are potentially curable when detected early, and eliminating disparities in screenings is part of the government's Healthy People 2010 plan, according to background information in the article.

"Medicaid is the largest provider of health insurance for minority populations in America. Medicaid recipients, by virtue of Medicaid eligibility criteria, frequently share other characteristics associated with health-related disparities: low income, old age, and/or chronic disability because of advanced disease, physical limitation, severe mental illness or developmental disability,” the authors wrote.

C. Annette DuBard, MD, of the North Carolina Department of Health and Human Services in Raleigh, and colleagues studied a representative sample of 1,951 state Medicaid recipients age 50 and older. Medical records were reviewed to determine whether physicians had recommended and patients had received cancer screening examinations.

"Documentation that colorectal, breast and cervical cancer screening was recommended by the primary care provider was found for only 52.7 percent, 60.4 percent and 51.5 percent of eligible patients, respectively," the authors wrote. "Documented rates of adequate screening were 28.2 percent for colorectal cancer, 31.7 percent for mammography within two years and 31.6 percent for Papanicolaou [cervical cancer] test within three years. When medical record and claims data were combined, approximately half of eligible patients had evidence of screening."

Despite Medicaid recipients' access to primary care and full coverage of cancer screening services, these rates are substantially lower than those in the general population, the authors noted.

"Lack of a screening recommendation by the physician, rather than patient refusal of recommended tests, accounted for most instances of screening delinquency," DuBard and colleagues concluded. "Efforts to increase cancer screening rates among Medicaid recipients must address patient, physician and organizational barriers to the routine identification and delivery of preventive services."