The Use of Screening Colonoscopy for Patients Cared for by the Department of Veterans Affairs

Colonoscopy has been proposed as the best available screening strategy for colorectal cancer (CRC), one of the most common causes of cancer deaths in men and women. Although it is the most costly and invasive among the choice of five recommended screening tests, colonoscopy use has increased significantly since 2001, when Medicare enacted coverage for beneficiaries at average risk for CRC. This study examines whether this national trend affected the Department of Veteran Affairs (VA), the single largest health care provider in the United States. Using data on patients aged 49 to 75 recorded by the VA, researchers found that CRC screening increased dramatically during fiscal years 1998-2003, but fecal occult blood testing (FOBT) remained the dominant mode of screening in the VA. While colonoscopy screening more than doubled in frequency in the VA, it still constitutes a small proportion of CRC screening.

The authors suggest that the striking difference from national trends may be accounted for by patient preferences and health care system characteristics in regard to endoscopic capacity and financial incentives. Further research should seek to uncover underlying reasons for these differences and compare patient outcomes across systems.