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Cancer screening practices may miss patients at high risk
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Primary care physicians’ cancer screening practices vary significantly and may not sufficiently target patients at increased risk for cancer, according to study results.
Researchers used the National Ambulatory Medical Care Survey to evaluate cancer screening practices of non-federally employed office-based physicians from 2005 to 2010.
The investigators evaluated practices for mammography and breast examinations in women older than 40 years, pelvic examinations and Pap smears in women aged 18 to 70 years, and digital rectal examinations and PSA testing for men aged 50 to 75 years.
Overall, researchers evaluated data from 8,521 office visits.
Clinical breast examinations were performed at a significantly higher rate than mammography (54.8% vs. 34.6%; P<.001). Pap smears and pelvic exams occurred at the same frequency (P=.087). PSA testing occurred more frequently than rectal examination (33.1% vs. 23%; P<.001).
Results showed mammography occurred less frequently than Pap smears (P<.001).
All screenings and tests occurred more frequently than skin examinations in adults aged at least 18 years (26.2%; P<.001).
The prevalence of pelvic examinations decreased from 59.9% in 2005-2007 to 56.7% in 2008-2010 (P=.016). Skin examinations increased from 25.1% to 27.1% (P=.032) between those two time periods. Skin examinations increased more dramatically in adults aged at least 50 years (26.2% to 29.3%; P=.013).
When researchers stratified results by age, they found women who underwent clinical breast examination were younger than those who did not (mean age, 46 vs. 50.6 years; P<.001), whereas women who underwent mammography were older than those who did not (mean age, 53.7 vs. 47.6 years; P<.001).
Women who underwent pelvic examinations (mean age, 44.8 vs. 51.3 years; P<.001) and Pap smears (mean age, 44.8 vs. 51.4 years; P<.001) were younger than those who did not.
Men who underwent digital rectal examinations (mean age, 52.1 vs. 47.8 years; P<.001) and PSA testing (mean age, 59.9 vs. 47.9 years; P<.001) were older than those who did not.
Non-Hispanic white patients more frequently received skin examinations (P<.001), mammography (P=.031), PSA testing (P=.003) and digital rectal examinations (P<.001).
Adults with Medicare or private insurance underwent more screening than patients with Medicaid or without insurance (P<.01).
“These findings are in line with numerous studies demonstrating a lack of access to care among nonwhites, stigma preventing certain cultures from seeking routine medical care like gynecologic screening, and distrust and misunderstanding of the US medical system among particular ethnic groups,” the researchers wrote. “These studies demonstrate why finding a solution to closing these gaps is especially imperative.”
Disclosure: The researchers report no relevant financial disclosures.
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