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CDC: Cancer screening rates remain below Healthy People 2020 targets
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The number of adults in the U.S. who underwent the recommended screening tests for breast, colorectal and cervical cancers in 2013 fell below the targets set by the Healthy People 2020 initiative, according to data published in CDC’s Morbidity and Mortality Weekly Report.
However, certain population subgroups — including highly educated women and older adults — approached or exceeded screening targets, according to the report.
“Although some demographic subgroups attained targets, screening use overall was below the targets with no improvement from 2010 to 2013 in breast, cervical or colorectal cancer screening use,” Susan A. Sabatino, MD, of the division of cancer prevention and control at the CDC, and colleagues wrote. “Cervical cancer screening declined from 2010 to 2013. Increased efforts are needed to achieve targets and reduce screening disparities.”
Screening data
The U.S. Department of Health and Human Services’ Healthy People 2020 initiative established target rates for screening compliance based on U.S. Preventive Services Task Force guidelines. These guidelines include:
- Mammography within 2 years among women aged 50-74 years;
- Pap test within 3 years among women aged 21-65 without hysterectomy; and
- Fecal occult blood test within 1 year, sigmoidoscopy within 5 years and fecal occult blood test within 3 years or colonoscopy within 10 years among men and women aged 50-75 years.
Sabatino and colleagues evaluated data from the National Health Interview Survey 2013, which was conducted to observe the progress toward achieving the goal target rates for compliance within each of these screening modalities.
Overall, approximately one in five eligible women did not receive recommended cervical cancer screenings, approximately one in four eligible women did not receive recommended breast cancer screenings and approximately two in five adults did not receive recommended colorectal cancer screenings.
Seventy-two percent of women aged 50 to 74 years underwent mammography in 2013, which was below the Healthy People 2020 target rate of 81.1% eligible women. A smaller proportion of women aged 50 to 64 years underwent mammography compared with women aged 65 to 74 years (71.4% vs. 75.3%), and Hispanic women were less likely to receive a mammogram than non-Hispanic women (66.5% vs. 73.2%).
Uninsured women (38.5%) and women lacking a usual source of care (29.7%) reported the lowest incidence of mammography.
Eighty percent of eligible women received a Pap test in 2013, which again was below the Healthy People 2020 target of 93%. Researchers observed the lowest incidence of Pap tests among Asians (70.1%), Hispanics (76.9%), women aged 51 to 65 years (77.6%) and foreign-born women (66%). Uninsured women (62%) and women without a primary care source (62.1%) demonstrated the lowest rates of use.
Further, the use of the Pap test decreased 5.5 percentage points between 2000 and 2013 (P < .001).
Fifty-eight percent of adults aged 50 to 75 years reported undergoing screening for colorectal cancer, whereas the Healthy People 2020 goal was 70.5%. Researchers observed the lowest rates of screening among individuals aged 50 to 64 years (52.8%), Asians (49.5%), Hispanics (41.5%), the uninsured (23.5%) and patients without a primary care source (17.5%). Men underwent screening at a significantly lower rate than women (P = .047).
Although the use of colorectal cancer testing increased 24.6 percentage points between 2000 and 2013 (P < .001) and every year between 2000 and 2010, screening rates did not increase in 2013.
“It is concerning to see a stall in colorectal cancer screening rates,” Lisa C. Richardson, MD, MPH, director of the division of cancer prevention and control at CDC, said in a press release. “We must find new ways to make people and providers aware that getting tested for colorectal cancer could prevent cancer and save their lives.”
Small areas of improvement
Researchers observed screening rate increases among certain subgroups of individuals. Women with a college degree or higher (81.2%) and women whose income exceeded the federal poverty level by 400% or more (81.8%) underwent mammography at a higher rate than the Healthy People 2020 target goal. Highly educated individuals and individuals with high incomes exceeded the average screening rates for cervical and colorectal cancer but fell short of reaching the CDC target.
Further, individuals aged 65 to 75 years nearly reached the CDC target for colorectal cancer screening (69.4%).
The researchers acknowledged several limitations of their study, including reliance on self-reported data and a response rate of 61% that allowed for a potential non-response bias. Further, researchers noted that screening guidelines and National Health Interview Survey have changed over time.
“Increased efforts are needed to reach Healthy People 2020 cancer screening guidelines and reduce disparities,” Sabatino and colleagues concluded. “More intensive and focused efforts might be required to overcome persistent barriers among specific population subgroups. Making available all colorectal cancer screening options might increase alignment of tests with individual needs and preferences and facilitate screening completion.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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