In Nutshell News: Virtual colonoscopy works just as well for over 65′s, over-the-counter and prescription stomach acid is connected to c. difficile diarrhea, and the recession cut into colorectal cancer screening among people with health insurance.
Older adults benefit from CT Colonography
CT colonography, so-called virtual colonoscopy, uses x-ray images to look into the colon. In the National CT Colonoscopy trial it was was as good at finding large polyps and cancers as optical colonoscopy. However, the Centers for Medicare and Medicaid Services (CMS) doesn’t cover the test, citing lack of evidence that it works for older adults.
Analyzing people 65 and older enrolled in the National Trial, researchers at the Mayo Clinic in Arizona found no significant differences between Medicare-aged people and younger participants. CT colonoscopy was able to find large adenomas and cancers at nearly the same rate in older and younger trial enrollees. There was also a very small difference between intermediate size polyps over 6 mm.
As might be expected, older adults had more polyps. About 7 out of 100 (6.9%) had large polyps or cancer compared to 4 out of 100 (3.7%) younger people.
C. Daniel Johnson and his team concluded,
For most measures of diagnostic performance and in most subsets, the difference between senior-aged participants and those younger than 65 years was not statistically significant.
FDA Warning: Stomach Acid Drugs Linked to C. Diff Infections
The FDA has warned proton pump inhibitors (PPIs) are associated with Clostridium difficile (C. difficile) diarrhea (CDAD). The warning includes both prescription and over-the-counter medicines to treat frequent heartburn and medical conditions including as gastroesophageal reflux disease (GERD), stomach and small intestine ulcers, and inflammation of the esophagus.
The FDA recommends that patients who are taking a PPI and develop diarrhea that doesn’t improve contact their healthcare professional.
Healthcare professionals are told:
- A diagnosis of CDAD should be considered for PPI users with diarrhea that does not improve.
- Advise patients to seek immediate care from a healthcare professional if they experience watery stool that does not go away, abdominal pain, and fever while taking PPIs.
- Patients should use the lowest dose and shortest duration of PPI therapy appropriate to the condition being treated.
Over-the-counter PPIs include Prevacid (lansoprazole), Prevacid 24hr, Prilosec (omeprazole), and Zegerid.
Additional prescription medicines are AcipHex (rabeprazole), Dexilant (dexlansoprazole), Nexium (esomeprazole), and Vimovo (esomeprazole and naproxen).
Recession Reduced Screening Colonoscopies for Insured
During the recent economic recession in the US, there were half a million fewer screening colonoscopies for patients with health insurance aged 50 to 64. The need to share costs through deductibles and copays appears to be part of the reason.
From December 2007 through November 2009, 500,000 fewer screening colonoscopies were done for patients with commercial insurance compared to the previous two years. Health plans with out-of-pocket costs over $300 had lower screening rates both before and during the recession. The recession had a smaller impact on plans with the lowest out-of-pocket requirements.
Reporting their analysis of reports from 106 health plans, Spencer Dorn, MD, MPH, and his team at the University of North Carolina wrote,
Policies to reduce cost sharing could increase adherence to recommended preventive services such as colonoscopy examinations.
Fight Colorectal Cancer is supporting the Removing Barriers to Colorectal Cancer Screening Act of 2012 (H.R. 4120) which would change Medicare law so that seniors wouldn’t face additional copayments when polyps were removed during a screening colonoscopy.