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US cancer screening rates drop
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Cancer screening rates declined in the United States during the past decade, and levels are less than optimal for many types of malignancies, according to study results.
Tainya C. Clarke
Conflicting recommendations between the US Preventive Services Task Force and the ACS regarding how often and at what age to be screened for certain cancers may have influenced the decline in screening participation, Tainya C. Clarke, MPH, MS, and colleagues wrote.
“As science improves, we are able to make better recommendations,” Clarke, a research associate in the department of epidemiology and public health at the University of Miami Miller School of Medicine, told HemOnc Today. “As investigators, we get excited and tell the public about these new recommendations. But as lay individuals, whenever things change, we get kind of suspicious. We want to know why the change was made. People who were just screened begin to wonder if they should get screened again or not at all. People tend to lose confidence in the public health system.”
The rise in uninsured Americans also may be a factor, Clarke said.
“If you do not have health insurance and you try to abide by the recommended screening, then costs become a factor, and you are less likely to have a screening within a set period of time,” she said.
Otis W. Brawley
Otis W. Brawley, MD, chief medical officer of the ACS, said he agrees with the data in the study, but added that trends are going to change soon.“A lot of the trends that are found in the study may change because of the Patient Protection and Affordable Care Act,” Brawley told HemOnc Today. “As insurers pay for more screening, things will get better.”
Decline in adherence
The most common screening tests include mammograms for breast cancer, Pap tests for cervical cancer, sigmoidoscopy and colonoscopy for colon and rectal cancers, and PSA tests for prostate cancer.
For this study, Clarke and colleagues examined the adherence to recommended breast, cervical, colorectal and prostate cancer screening.
The researchers identified 174,393 adults aged at least 18 years who participated in the National Health Interview Survey from 1997 to 2010. Detailed cancer screening information was available for those participants.
Using ACS screening recommendations as a guide, the investigators assessed adherence to screening for breast, cervical, colorectal and prostate cancer during this time.
They compared screening rates for the general public with the rates of cancer survivors (n=12,990) and a subgroup of working cancer survivors (n=7,528).
The results showed a general decline in adherence to recommended screening throughout the decade.
Screening rates for the general population failed to reach the goals of Healthy People 2010, a federal health promotion and disease prevention initiative, for all targeted cancers except for colorectal cancer.
Colorectal cancer screening rates increased by 16.6% during the study period, and an estimated 54.6% of those aged older than 50 years underwent a colorectal examination, surpassing the Healthy People 2010 goal of 50%.
Mammography rates were little changed during the study period but fell just short of the Healthy People 2010 goal of 70%.
The rate of women who reported undergoing Pap tests for cervical cancer dropped 3.7% from 1999 to 2010. The percentage of eligible men who reported getting a PSA test within the previous 12 months declined from 64.6% in 1999 to 46% in 2010, study results showed. Both rates were below Healthy People 2010 objectives.
Screening for survivors
Cancer survivors demonstrated a higher adherence to recommended screening compared with those who had no cancer history, results showed.
Cancer survivors met Healthy People 2010 goals for all targeted malignancies except cervical cancer, for which screening rates declined by an average of 1.5% per year during the study period. In 2010, 77.8% of cancer female cancer survivors reported undergoing a Pap test, well below the Healthy People 2010 goal of 90%.
“This really stood out for us,” Clarke said. “As HPV vaccination increases, we have begun to notice a decrease in cervical cancer screening. It is great that HPV vaccination is increasing, but the vaccination doesn’t protect you from all of the many cancer-causing HPV infections. It’s important to drive home that message.”
Researchers also said, in 2010, fewer cancer survivors reported undergoing screenings within the past 3 years.
“Despite demonstrating higher screening rates than the general population, it is evident that cancer survivors had a slight decline in screening rates and are in need of continued medical advice post-treatment and diagnosis,” Clarke and colleagues wrote.
Risk vs. reward
The general population is beginning to appreciate that certain screening tests, such as PSA tests, may do more harm than good by causing patients to undergo unnecessary treatments for diseases that will not progress. In those cases, eligible patients may avoid screening.
“More and more people understand that there is a harm associated with cancer screening,” Brawley said. “When the benefit is clearly greater than the harm, then we recommended screening.”
The public debate over the value of cancer screening is likely to continue as new scientific discoveries lead to more changes to recommendations, which are intended to guide the general population.
“Each individual’s risk is different,” Clarke said. “It is very important that people still consider their family background or what their individual exposures are.”
Reference:
Clarke TC. Front Oncol. 2012;doi:10.3389/fonc.2012.00190.
For more information:
Otis W. Brawley, MD, can be reached at Georgia Cancer Center for Excellence, Grady Memorial Hospital, 80 Jesse Hill Jr. Drive, Atlanta, GA 30303; email: otis.brawley@cancer.org.
Tainya C. Clarke, MPH, MS, can be reached at Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, 1120 NW 14th St., Miami, FL 33136; email: tclarke2@med.miami.edu.
Disclosure: Clarke and Brawley report no relevant financial disclosures.