Accuracy of Self-report for Cervical and Breast Cancer Screening: A Systematic Review and Meta-analysis

Abstract

Background: Guideline-based breast and cervical cancer screenings are fundamental components of high-quality preventive women’s health care services. Accurate measurement of screening rates is vital to ensure all women are adequately screened. Our systematic review and meta-analysis aims to provide an updated synthesis of the evidence on the accuracy of self-reported measures of cervical and breast cancer screening compared to medical records. Methods: To identify studies, we searched MEDLINE®, Cochrane Database of Systematic Reviews, and other sources up to July 2019. Two reviewers sequentially selected studies, abstracted data, and assessed internal validity and strength of the evidence. Adjusted summary numbers for sensitivity and specificity were calculated using a bivariate random-effects meta-analysis. Results: Unscreened women tended to over-report screening among 39 included studies examining the accuracy of self-report for cervical and/or breast cancer screening. The specificity of self-report was 48% (95% CI 41 to 56) for cervical cancer screening and 61% (95% CI 53 to 69) for breast cancer screening while the sensitivity of self-report was much higher at 96% (95% CI 94 to 97) for cervical cancer screening and 96% (95% CI 95 to 98). We have moderate confidence in these findings, as they come from a large number of studies directly assessing the accuracy of self-report compared to medical records and are consistent with findings from a previous meta-analysis. Conclusions: Unscreened women tend to over-report cervical and breast cancer screening, while screened women more accurately report their screening. Future research should focus on assessing the impact of over-reporting on clinical and system-level outcomes.

Recall accuracy of notifications about incidental findings from an MRI examination: results from a population-based study

“…We observed a low specificity of self-reported notifications of 75% in SHIP. Even lower specificities were reported for recall of screening examinations in breast cancer (61% 28 ) and cervical cancer (48% 28 ), which are comparable to the procedure applied in the present study. Presumably, the relevance of results from screening examinations is lower for most participants or patients compared to the recall of cancer diagnoses.…”

Validity of self-reported mammography uptake in the Belgian health interview survey: selection and reporting bias

“…Early detection of breast cancer through mammography screening is recognized as being effective in reducing mortality 5 , 6 ; in women aged 50–69 years. 7–9 Literature suggests that with a screening attendance reaching 70%, a reduction in breast cancer mortality by about 25% might be expected.…”

“…Currently, information on screening is often based on self-reports in population-based surveys. 5 , 6 , 12 , 13 Such information is used to monitor screening rates over time and to target interventions. However, the validity of self-reported information through surveys is a concern due to a potential selection (because of non-coverage or non-response error) and reporting bias associated with differential survey participation.…”

“…For example, it has been shown that members of ethnic minority groups and people with a lower socioeconomic status are more likely to inaccurately report cancer screening than their counterparts. 5 , 13 , 14 …”

“…Numerous validation studies and meta-analyses have documented the level of agreement/disagreement between self-reported cancer screening and cancer registers, claims databases, electronic medical records and administrative data. 5 , 6 , 12 , 13 They have reported a sensitivity between 95% and 97%, a specificity between 61% and 64% and have concluded that the estimates based on self-report are usually over-estimated. 5 , 12 However, most of these validation studies are either limited to a specific geographical region 6 , 19–21 or a specific subgroup 13 , 14 , leading to a problem of generalizability.…”