Cancer Screening Among U.S. Medicaid Enrollees with Chronic Comorbidities or Residing in Long-Term Care Facilities


  • Michael T. Halpern RTI International, Washington, DC and Waltham, MA, USA
  • Susan G. Haber RTI International, Washington, DC and Waltham, MA, USA
  • Florence K. Tangka CDC, Atlanta, GA, USA
  • Susan A. Sabatino CDC, Atlanta, GA, USA
  • David H. Howard Emory University, Atlanta, GA, USA
  • Sujha Subramanian RTI International, Washington, DC and Waltham, MA, USA



Neoplasms, Medicaid, Mass Screening, Healthcare Disparities, Nursing Homes.


Background: Ensuring appropriate cancer screenings among low-income persons with chronic conditions and persons residing in long-term care (LTC) facilities presents special challenges. This study examines the impact of having chronic diseases and of LTC residency status on cancer screening among adults enrolled in Medicaid, a joint state-federal government program providing health insurance for certain low-income individuals in the U.S.

Methods: We used 2000-2003 Medicaid data for Medicaid-only beneficiaries and merged 2003 Medicare-Medicaid data for dually-eligible beneficiaries from four states to estimate the likelihood of cancer screening tests during a 12-month period. Multivariate regression models assessed the association of chronic conditions and LTC residency status with each type of cancer screening.

Results: LTC residency was associated with significant reductions in screening tests for both Medicaid-only and Medicare-Medicaid enrollees; particularly large reductions were observed for receipt of mammograms. Enrollees with multiple chronic comorbidities were more likely to receive colorectal and prostate cancer screenings and less likely to receive Papanicolaou (Pap) tests than were those without chronic conditions.

Conclusions: LTC residents have substantial risks of not receiving cancer screening tests. Not performing appropriate screenings may increase the risk of delayed/missed diagnoses and could increase disparities; however, it is also important to consider recommendations to appropriately discontinue screening and decrease the risk of overdiagnosis. Although anecdotal reports suggest that patients with serious comorbidities may not receive regular cancer screening, we found that having chronic conditions increases the likelihood of certain screening tests. More work is needed to better understand these issues and to facilitate referrals for appropriate cancer screenings.


Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst 2010; 102: 605-13.

Castellano PZ, Wenger NK, Graves WL. Adherence to screening guidelines for breast and cervical cancer in postmenopausal women with coronary heart disease: an ancillary study of volunteers for hers. J Womens Health Gend Based Med 2001; 10: 451-61.

Heflin MT, Pollak KI, Kuchibhatla MN, Branch LG, Oddone EZ. The impact of health status on physicians' intentions to offer cancer screening to older women. J Gerontol A Biol Sci Med Sci 2006; 61: 844-50.

McBean AM, Yu X. The underuse of screening services among elderly women with diabetes. Diabetes Care 2007; 30: 1466-72.

Jaen CR, Stange KC, Nutting PA. Competing demands of primary care: a model for the delivery of clinical preventive services. J Fam Pract 1994; 38: 166-71.

Hamblin JE. Physician recommendations for screening mammography: results of a survey using clinical vignettes. J Fam Pract 1991; 32: 472-7.

Marwill SL, Freund KM, Barry PP. Patient factors associated with breast cancer screening among older women. J Am Geriatr Soc 1996; 44: 1210-4.

Ward E, Halpern M, Schrag N, Cokkinides V, DeSantis C, Bandi P, et al. Association of insurance with cancer care utilization and outcomes. CA Cancer J Clin 2008; 58: 9-31.

Centers for Medicare & Medicaid Services. Medicaid Data Sources – General Information. 2012 [monograph on the internet]. Baltimore, MD: Centers for Medicare & Medicaid Services; 2012 [cited 2013 January 25]: Available from Computer-Data-and-Systems/MedicaidDataSourcesGenInfo/ index.html

Kerins G, Gruman C, Schwartz R, Rauch EA, Curry L, Fogel D. Mammography utilization in a skilled nursing facility. Conn Med 2000; 64: 595-9.

Wallace JB, Prevost SS. Two methods for predicting limited life expectancy in nursing homes. J Nurs Scholarsh 2006; 38: 148-53.

Flacker JM, Kiely DK. Mortality-related factors and 1-year survival in nursing home residents. J Am Geriatr Soc 2003; 51: 213-21.

Spillman BC, Lubitz J. New estimates of lifetime nursing home use: have patterns of use changed? Med Care 2002; 40: 965-75.

Bradley CJ, Clement JP, Lin C. Absence of cancer diagnosis and treatment in elderly Medicaid-insured nursing home residents. J Natl Cancer Inst 2008; 100: 21-31.

Clement JP, Bradley CJ, Lin C. Organizational characteristics and cancer care for nursing home residents. Health Serv Res 2009; 44: 1983-2003.

Bandieri E, Sichetti D, Romero M, Fanizza C, Belfiglio M, Buonaccorso L, et al. Impact of early access to a palliative/supportive care intervention on pain management in patients with cancer. Ann Oncol 2012; 23: 2016-20.

Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010; 363: 733-42.

Kahi CJ, van Ryn M, Juliar B, Stuart JS, Imperiale TF. Provider recommendations for colorectal cancer screening in elderly veterans. J Gen Intern Med 2009; 24: 1263-8.

Shokar NK, Nguyen-Oghalai T, Wu H. Factors associated with a physician's recommendation for colorectal cancer screening in a diverse population. Fam Med 2009; 41: 427-33.

Nosek MA, Howland CA. Breast and cervical cancer screening among women with physical disabilities. Arch Phys Med Rehabil 1997; 78: S39-44.

Pirraglia PA, Sanyal P, Singer DE, Ferris TG. Depressive symptom burden as a barrier to screening for breast and cervical cancers. J Womens Health (Larchmt) 2004; 13: 731-8.

Lord O, Malone D, Mitchell AJ. Receipt of preventive medical care and medical screening for patients with mental illness: a comparative analysis. Gen Hosp Psychiatry 2010; 32: 519-43.

Fisher DA, Galanko J, Dudley TK, Shahee NJ. Impact of comorbidity on colorectal cancer screening in the Veterans Healthcare System. Clin Gastroenterol Hepatol 2007; 5: 991-6.

Short PF, Graefe DR, Schoen C. Churn, Churn, Churn: How Instability of Health Insurance Shapes America’s Uninsured Problem [monograph on the internet]. New York: The Commonwealth Fund; 2003 [cited 2013 January 25]: Available from 688Shortchurnchurnchurnhowinstabilityofhltinsuranceissuebrief-320.pdf




How to Cite

Michael T. Halpern, Susan G. Haber, Florence K. Tangka, Susan A. Sabatino, David H. Howard, & Sujha Subramanian. (2013). Cancer Screening Among U.S. Medicaid Enrollees with Chronic Comorbidities or Residing in Long-Term Care Facilities . Journal of Analytical Oncology, 2(2), 98–106.