Patients in Lower-Income Communities May Be Less Likely to Receive CT Colonography Than Those in Higher-Income Communities

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Patients who reside in lower-income communities may be less likely to undergo colorectal cancer screenings with computed tomography (CT) colonography than those who reside in higher-income communities, according to a new study published by Christensen et al in the American Journal of Roentgenology.


Medicare provides coverage for all guideline-recommended colorectal cancer screening strategies. However, coverage is excluded for CT colonography.

“Medicare’s noncoverage for screening CT colonography may … contribute to income-based disparities in CT colonography use,” stressed lead study author Eric Christensen, PhD, Adjunct Professor of Health Services Management at the University of Minnesota College of Continuing & Professional Studies and Director of Economics and Health Services Research at the Harvey L. Neiman Health Policy Institute.

Study Methods and Results

In the new study, the investigators examined the data of Medicare fee-for-service beneficiaries who received 785,103 colorectal cancer screening tests from 2011 and 2020. They discovered that Medicare fee-for-service beneficiaries living in communities with an annual per capita income of $100,000 or more were 5.7 times more likely to receive a CT colonography than those living in communities with an annual per capita income of less than $25,000.

Although higher income was also associated with a 36%, 50%, and 43% greater likelihood of screening by optical colonoscopy, guaiac fecal-occult blood test or fecal immunochemical test, and stool DNA test, respectively, the investigators found that 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.


“Optical colonoscopy is often considered to be the gold standard for colorectal cancer screenings, yet some [patients] 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,” emphasized co–study author Pina Sanelli, MD, MPH, FACR, Professor of Radiology at the Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health as well as Vice Chair of Research and Executive Director of Imaging Clinical Effectiveness and Outcomes Research at the Feinstein Institutes for Medical Research. “Medicare coverage of screening CT colonography could potentially reduce income-based disparities for individuals avoiding optical colonoscopy,” she added.

“The Affordable Care Act mandates that private health insurance plans cover all screening strategies recommended by the U.S. Preventive Services Task Force with a grade of A or B—which includes screening CT colonography. This mandate does not apply to Medicare. It is unclear as to why [the Centers for Medicare & Medicaid Services] does not cover screening CT colonography as it does for all other guideline recommended colorectal cancer screening strategies,” noted senior study author Judy Yee, MD, FACR, Professor of Radiology at the Albert Einstein College of Medicine and Chair of the Department of Radiology at the Montefiore Health System. “Medicare coverage of screening CT colonography could lessen income-based access disparities as well as downstream colorectal cancer disparities—since CT [colonography] can lead more [patients] to be screened so that cancers are prevented completely or detected early,” she concluded

Disclosure: For full disclosures of the study authors, visit

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