Cancer Screening of Older Women A Primary Care Issue

Abstract

Barriers for appropriate cancer screening for older women exist for both the provider and the patient; however, many of these obstacles can be overcome. Improving the resident's exposure to the current recommendations, increasing geriatric content in the training program, and initiating a reminder system may reduce some of the provider barriers. The use of midlevel providers may increase the preventive services offered to older women as well as educate and empower these women to become responsible for their own healthcare. Together, physicians and midlevel providers can become patient advocates through political activism, encouraging legislation that guarantees payment for cancer screening tests. Finally, primary care providers can become actively engaged in research that explores the healthcare concerns of older women.

Prevalence of Colorectal Cancer Screening in a Large Medical Organization

“…Rates of testing according to recommended methods, occult blood testing by 3-day kit and SIG, were Ͻ50%, whereas rates of occult blood testing by DRE were higher than expected. These results are similar to other studies that have evaluated CRC screening prevalence using medical record review (22)(23)(24). In a retrospective review of Ͼ5000 medical records, Ruffin et al (22) found rates of FOBT by DRE, FOBT by 3-day kit in the previous year, and SIG in the past 5 years to be ϳ35, 27, and 20%, respectively.…”

“…If specific symptoms were listed leading to the test, the test was considered diagnostic. Because previous studies have not clearly distinguished between tests done for screening versus diagnosis or follow-up (18,19,(22)(23)(24), we used receipt of CRC tests for any reason as our primary outcome (i.e., FOBT by DRE in past year, FOBT by 3-day kit in past year, SIG in past 5 years, and COL in past 10 years). However, we also evaluated receipt of FOBT by 3-day kit or SIG in the past 5 years, excluding tests that were not done specifically for screening.…”

“…To address our secondary objective, we compared prevalence rates obtained from medical record audit with those from our survey of physicians who were practicing in the same medical environment during an overlapping time period (1998Ref. 25).…”

“…Few studies have used the medical record to evaluate CRC screening, although it is considered the gold standard for determining services received compared with patient or physician self-report (21). Two studies used medical records to evaluate prevalence of cancer screening services including CRC screening (22,23), whereas another focused specifically on CRC screening (24). One of these studies evaluated screening only among women (23), one used records from community-based practices where receipt of tests was not always known (22), and one used an electronic medical record to assess screening prevalence (24).…”

“…Two studies used medical records to evaluate prevalence of cancer screening services including CRC screening (22,23), whereas another focused specifically on CRC screening (24). One of these studies evaluated screening only among women (23), one used records from community-based practices where receipt of tests was not always known (22), and one used an electronic medical record to assess screening prevalence (24). Screening rates in these studies ranged from 35 to 37% for occult blood testing by DRE, 25 to 45% for FOBT by a 3-day kit, and 10 to 25% for SIG (22)(23)(24).…”