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CDC: US in danger of not meeting many cancer screening goals
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The use of screening tests for breast, cervical and colorectal cancer in 2015 remained below Healthy People 2020 targets, according to data recently published in Preventing Chronic Disease.
According to researchers, Healthy People 2020 objectives for use of cancer screening tests include increasing the proportion of women aged 50 to 74 years screened for breast cancer, women aged 21 to 65 years screened for cervical cancer, and men and women aged 50 to 75 years screened for colorectal cancer.
“Monitoring screening in subgroups is essential to determine what allocation of resources and efforts is necessary to increase screening participation and improve cancer outcomes for all,” Ingrid J. Hall, PhD, MPH, of the National Center for Chronic Disease Prevention and Health Promotion at CDC told Healio Family Medicine.
Researchers noted that breast, cervical, colorectal and prostate cancers accounted for nearly 40% of all new cancer diagnoses and about 20% of cancer deaths in 2013.
Hall and colleagues reviewed National Health Interview Survey data for 2000 through 2015 to determine cancer screening prevalence in accordance with U.S. Preventive Services Task Force recommendations among “traditionally underserved population subgroups.” They found:
- 71.7% (95% CI, 70.2-73.1) of women aged 50 to 74 years said they had a recent mammogram, 9.4% short of the Healthy People 2020 target.
- 61.9% (95% CI, 60-63.7) of men aged 50 to 75 years said they had a recent colorectal cancer screening, 8.6% short of the Healthy People 2020 target.
- 63.4% (95% CI, 61.7-65) of women aged 50 to 75 years said they had a recent colorectal cancer screening test, 7.1% short of the Healthy People 2020 target.
- 81.3% (95% CI, 80.3-82.3) of women aged 21 to 65 years said they had a recent Pap test, 11.7% short of the Healthy People 2020 target.
- Only colorectal cancer screening increased in 2015.
Hall said primary care physicians play a critical role in reaching the Healthy People 2020 targets and discussed ways to increase screening rates.
“One approach ... would be for physicians to talk about the pros and cons of screening with all age-appropriate patients, including traditionally underserved groups (low-income, uninsured, low acculturation or assimilation, Hispanic, Asians, the uninsured, and the less educated).”
“Culturally- and linguistically-tailored strategies may be useful to educate and inform and may increase knowledge and intention to screen among underserved groups and may be particularly effective for Asians who are disproportionately affected by discordance in patient–provider language and gender (provider and patient being of different genders),” she added.
The CDC website ‘Screen Out Cancer’ provides other strategies, such as sending reminders to patients and potentially offering alternative office hours, mobile clinics, and transportation to increase the number of screenings. – by Janel Miller
Disclosure: The authors report no relevant financial disclosures.
Perspective
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Robert A. Smith, PhD
For nearly 40 years, leading organizations have regularly issued and refined cancer screening guidelines. So, upon reading the report by Hall and colleagues, it is fair to ask, “why are today’s screening rates so low (since they are self-reported, actual rates are lower), and unchanging over the past decade (with the exception of colorectal cancer screening)?
At the most fundamental level, there are two reasons. First, in the U.S., we do not have a system of organized cancer screening. Recent cancer screening is strongly associated with health insurance, a usual source of care, and a recent encounter with a health care provider, especially for preventive care, which all adds up to a greater likelihood that there has been an opportunity for a health care professional to recommend cancer screening. Second, we have significant access barriers to cancer screening in this country, including not only the complement to the enabling factors listed above, but racial, cultural, and geographic barriers. Our present non-system is inefficient, and the stress on primary care is growing. As new cancers are added to screening recommendations (eg, lung cancer), and the opportunities for personalized medicine point us in the direction of more tailored, risk-based screening, the demands on primary care will increase, and in the absence of a system, only worsen.
It is time to recognize that high rates of regular cancer screening will not be achieved as long as we rely on an encounter-based model. It depends too much on a coincidence of interest and opportunity, and too many adults who cannot access health care are entirely left out. Primary care needs the systems and incentives to deliver population-based cancer screening.
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