06.27.22
By Son of Inequity
Part 3
This is Part 3 in a series of blogs about my diagnosis and recovering from colorectal cancer. To start at the beginning, click here for Part I or Part II.
All told, the biopsies, tests, my surgery and follow-ups appointments cost nearly $40,000!
And I was lucking.
Treating stage 3 or 4 CRC—which is what most African American CRC patients must face—easily exceeds $100,000.
According to the Centers of Disease Control, CRC surgery and treatment costs the U.S. $14.1 billion in 2014. The CDC estimates that it is now over $20 billion. More than 10 percent of the cancer treatment costs in the U.S. is spent on CRC. In fact, CRC is the second most costly cancer in the U.S.
But that’s just the tip of the iceberg. For the year 2006, it is estimated that the lost productivity cost for people who are diagnosed with CRC was $15.3 billion, or $288,468 per person.
Now, contrast these incomprehensible financial and human costs with the cost of screening:
- Colonoscopy cost about $1,500 every 5 years, for an annual total of $300
- Cologuard costs about $500 every 5 years, for an annual total of $100
- FIT and other fecal blood tests costs between $30 and $90, depending on the brand but must be done annually
But remember from Part I of this blog that Cologuard is more accurate that FIT:
In a 2014 head-to-head comparison of FIT and Cologuard, published in the New England Journal of Medicine, Cologuard detected colorectal cancer accurately 92 percent of the time while FIT was accurate only 73.8 percent of the time. Cologuard was also better at detecting early tumors, or advanced precancerous lesions, than FIT, with a 42% accuracy for Cologuard and 23% accuracy for FIT.
FIT simply misses a huge number of colon cancers—compared to Cologuard and colonoscopy—a disproportionate number of which occur in African Americans. Conversely, Cologuard is more accurate and is designed to find tumors that are specific to African Americans.
I haven’t done the math, but I’m certain that Cologuard not only saves more lives than FIT, it saves more money too.
“The only color that really matters is green.”
This was one of my grandfather’s favorite sayings. When it came to racial hatred or racial solidarity, both could be overcome by money. There’s a lot of truth here, but every rule has some exceptions.
Because genetic testing finds tumors long before there are any symptoms, like in my case, it allows for early intervention when medical care is much cheaper and more likely to succeed. So, you would think payors would go out of their way to test high-risk patient groups with genetic tests. Afterall, it would save them money.
Here’s the exception to my grandfather’s favorite saying. Payors, private ones as well as public ones like Medicare and Medicaid—are actively trying to reduce genetic testing for cancers, particularly breast and colorectal cancers. Both tumors cost the most to treat and disproportionately impact African Americans.
“STFU!” No, you heard me right.
Despite the fact that genetic testing for CRC in African Americans is readily available and affordable, African Americas are often not even told that this option exists. A 2018 study titled Low Referral Rate for Genetic Testing in Racially and Ethnically Diverse Patients Despite Universal Colorectal Cancer Screening concluded:
“Overall, 92% of colorectal tumors were analyzed for mismatch repair deficiency without significant differences among races/ethnicities. However, minority patients were significantly less likely to be referred for genetic evaluation (21.2% for NHW patients vs 16.9% for African American patients and 10.9% for Hispanic patients; P = .02). Rates of genetic testing were also lower among minority patients (10.7% for NHW patients vs 6.0% for AA patients and 3.1% for Hispanic patients; P < .01). On multivariate analysis, African American race, older age, and medical center were independently associated with lack of referral for genetic evaluation and genetic testing.”
Just a reminder: African Americans have the highest mortality rate from colorectal cancer than any ethnic group in the United States!
If your head is still stuck in the sand and you want to hold onto the idea that CRC is a strange anomaly in the U.S. healthcare system, guess again. A study published in April of this year in the journal Oncologist reveals that genetic testing for the three most deadly cancers to African Americans are severely underutilized in the diagnosis of African Americans.
“STFU!” Are you beginning to see the pattern?
These researchers looked specifically at breast tumors that result from a genetic mutation called BRCA1/2. These tumors are extremely difficult to treat and are very deadly. But, when diagnosed early, survivability improves dramatically and treatment costs decrease dramatically.
The researchers report that in a population of 28,000 breast cancer patients, 5.65% of African American women carried the BRCA1/2 gene compared to 5.06% for non-Hispanic White women with breast cancer. But Black women were still less likely to be tested for this cancer-causing mutation.:
“However, compared with other races and ethnicities, African-American patients with breast cancer have lower rates of referral for genetic evaluation.”
The authors of the Oncologist paper cite additional research revealing that “41.2% of African-American women who were eligible for BRCA1/2 mutation testing according to National Comprehensive Cancer Network (NCCN) guidelines did not receive it as part of their routine care. Healthcare providers were 16 times less likely to discuss genetic testing with African Americans than with their non-Hispanic White counterparts.”
This research revealed the same deadly trend among Black men with prostate cancer, which is the second most common cause of cancer-related death in African-American men. Prostate cancer occurs much more frequently and at an earlier age in African Americans than in Whites. 1 in 7 African American men and 1 in 9 non-Hispanic White men will be diagnosed with prostate cancer in the U.S. The 5-year mortality for African Americans remains 2.5-fold higher than for White American men with prostate cancer. Despite all of this evidence for early detection with readily available genetic tests, African American men are far less likely to receive genetic testing for prostate cancer compared to White men.
So why does this still happen. There seems to be three broad answers:
- It’s a long-ignored oversight by a well-intentioned healthcare system.
- It’s an unfortunate blind spot in a system designed by white Americans for white Americans.
- It is the callous disregard for the lives of African Americans.
I still don’t know the answer to that question. The doctor who pleaded with me to get a CRC screen is white. And he saved my life. Depending on my mood and the day of the week, I’m likely to blame all three.
But in the next post in this series, I’m going to discuss something that makes me OTT, FTS, burn-it-all-down cynical.
I’m going to reveal that insurance providers—starting with Medicare and Medicaid—are actively trying to reduce access to Cologuard and the genetic tests that identify BRAC1/2 breast cancers: two of the deadliest tumors to African Americans.
Not only are they trying to reduce access, they’ve already successfully reduced access. How do I know? Because they brag about it on their own website.