Progress in cancer screening practices in the United States

Abstract

BACKGROUNDUnderstanding differences in cancer screening among population groups in 2000 and successes or failures in reducing disparities over time among groups is important for planning a public health strategy to reduce or eliminate health disparities, a major goal of Healthy People 2010 national cancer screening objectives. In 2000, the new cancer control module added to the National Health Interview Survey (NHIS) collected more detailed information on cancer screening compared with previous surveys.METHODSData from the 2000 NHIS and earlier surveys were analyzed to discern patterns and trends in cancer screening practices, including Pap tests, mammography, prostate specific antigen (PSA) screening, and colorectal screening. The data are reported for population subgroups that were defined by a number of demographic and socioeconomic characteristics.RESULTSWomen who were least likely to have had a mammogram within the last 2 years were those with no usual source of health care (61%), women with no health insurance (67%), and women who immigrated to the United States within the last 10 years (61%). Results for Pap tests within the last 3 years were similar. Among both men and women, those least likely to have had a fecal occult blood test or endoscopy within the recommended screening interval had no usual source of care (14% for men and 18% for women), no health insurance (20% for men and 18% for women), or were recent immigrants (20% for men and 18% for women). An analysis of changes in test use since the 1987 survey indicates that the disparities are widening among groups with no usual source of care.CONCLUSIONSNo striking improvements have been observed for the groups with greatest need. Although screening use for most groups has increased since 1987, major disparities remain. Some groups, notably individuals with no usual source of care and the uninsured are falling further behind; and, according to the 2000 data, recent immigrants also experience a significant gap in screening utilization. More attention is needed to overcome screening barriers for these groups if the population benefits of cancer screening are to be achieved. Cancer 2003;97:1528–40. Published 2003 by the American Cancer Society.DOI 10.1002/cncr.11208

Cervical cancer survivors at increased risk of subsequent tobacco-related malignancies, United States 1992–2008

“…NH black, API, AI/AN, and Hispanic women each account for a larger proportion of cervical cancer survivors than breast or colorectal cancer survivors. Higher rates of cervical cancer among non-white women are well documented and are often attributed to differences in Pap testing, including treatment of pre-invasive disease and follow-up of abnormal test results [19][20][21][22]. We also found that women diagnosed with cervical cancer have the highest risk of developing a subsequent tobacco-related malignancy over a 15-year period immediately following diagnosis, which then decreases to risks similarly observed in other cancer survivors.…”

“…Scientific advances in cervical cancer prevention, screening to achieve early detection, and treatment have largely decreased the cervical cancer burden in the United States, thus making cervical cancer a model for cancer prevention and control [36]. However, cervical cancer survivors may face an increased risk of a subsequent tobacco-related cancer diagnosis due to prior treatment [37], and their high prevalence of persistent smoking after a cancer diagnosis [9,10].…”

Get Screened: A Randomized Trial of the Incremental Benefits of Reminders, Recall, and Outreach on Cancer Screening

“…Numerous strategies exist to improve screening rates for colorectal and breast cancer, 2,3,5,6,[11][12][13][14][15][16][17][18][19][20] but the relative incremental benefit of these interventions have not been compared. 5 Using a pragmatic randomized trial, we examined the incremental benefit of several strategies to augment the effect of a patient reminder letter to improve cancer-screening rates.…”

An examination of racial differences in 5‐year survival of cervical cancer among African American and white American women in the southeastern US from 1985 to 2010

“…Lack of facilities to screen with a Pap test is the most common attributable factor in the development of invasive CC 39, 40, 41, 42. In this study, diagnosis of AAs at an older age and advanced tumor stage compared to White Americans may be due to lower socioeconomic status, access to screening facilities or cultural barriers.…”

“…The racial difference in stage at diagnosis may be due to differences in the quality of screening and follow‐up after abnormal pap results 6. Access to quality health care is often compromised among under‐served minorities, particularly AA women, the uninsured and older women 41, 42.…”