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Colonoscopy Coverage: 27 States Flunk

A study finds that only 15 states require health insurers to cover the lifesaving procedure, plus future colon-cancer screening technologies

There is only one cancer screening test that has been definitively proven to save lives—a colonoscopy for colon cancer. But a new survey finds that only 20 states, plus the District of Columbia, have laws mandating that insurance providers cover the cost of colonoscopies. That could mean many lives lost, because the same study found that screening rates in those states that mandate coverage have risen 40% faster than in states without such mandates.

Colon cancer is expected to kill some 52,100 people in the U.S. this year, making it the second-leading cause of cancer death after lung cancer. However, it is also the most curable: If detected early, 90% of patients can be cured through surgery and follow-up treatment. Still, in its annual report card on states and their screening laws, a coalition of health-care groups found that last year only one state, Alaska, passed legislation requiring insurance coverage for the test. In contrast, 47 states require insurance coverage for mammograms, while 20 states mandate coverage for prostate cancer screening, a highly controversial test that has yet to prove it can extend survival rates.

Expensive but Effective

In a colonoscopy, a lighted tube with a camera is threaded through the colon to search for abnormal growths called polyps. It is regularly described as the gold standard of cancer screening. The procedure not only detects cancerous polyps on the colon wall, but can actually facilitate the removal of precancerous lesions, so that they never turn deadly. Although the test is expensive—costing anywhere from $500 to $1,000—standard guidelines call for it to be repeated only once every seven to 10 years if the first test, usually given after age 50, proves negative. Most other cancer tests are administered annually.

But the price tag, combined with some squeamishness about the procedure, has hindered the colonoscopy's widespread use. Only 45% of the at-risk population (people 50 and above and younger people with other risk factors) report having undergone screening for colon cancer in the past 10 years. "It's primarily about the cost, not about the science or the need," says Dr. David Johnson, president of the American College of Gastroenterology. But colon cancer itself is one of the most expensive cancers to treat, with the drugs alone costing $120,000 for the late-stage disease. "Multiple analyses have found colonoscopies to be a very cost-effective screening test," says Johnson.

Report Card

The Colorectal Cancer Legislation Report Card, first issued in 2004, gave 15 states, plus the District of Columbia, an "A" grade for laws mandating coverage of colonoscopies as well as future advances in screening technologies: Arkansas, Alaska, Connecticut, Georgia, Illinois, Indiana, Louisiana, Maryland, Missouri, Nevada, New Jersey, North Carolina, Oregon, Rhode Island, Virginia, and Washington, D.C. State laws requiring insurance coverage of colon cancer screening have significantly increased the number of potentially lifesaving screenings in those states, according to an analysis by the American Cancer Society.

States that received an "F," for having no legislation requiring coverage, included Arizona, Colorado, Florida, Hawaii, Idaho, Iowa, Kansas, Kentucky, Maine, Massachusetts, Michigan, Minnesota, Mississippi, Montana, Nebraska, New Hampshire, New Mexico, New York, North Dakota, Ohio, Pennsylvania, South Carolina, South Dakota, Utah, Vermont, Washington, and Wisconsin. The remaining states require or recommend only some level of coverage.

Arnst is a senior writer for BusinessWeek based in New York.

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