USA CANCER SCREENING RATES

Although cancer screening rates have been increasing in the United States, they are still below national targets, says the Centers for Disease Control and Prevention (CDC).

The use of cancer screening tests for cervical, breast, and colorectal cancer have stayed below the Healthy People 2020 targets. This was particularly the case among individuals without health insurance, a new CDC study concludes.

Other factors associated with lower rates of screening included having no contact with a healthcare provider during the past year, having no usual source of healthcare, being younger, having lower income, and having fewer years of education.

The study was published online July 26 in Preventing Chronic Disease.

Researchers used data collected by the National Health Interview Survey (NHIS), which has been used for over 3 decades to assess progress toward meeting Healthy People objectives for cancer screening.

Respondents were asked questions regarding Papanicolaou (Pap) testing and hysterectomy for cervical cancer screening, mammograms for breast cancer screening, prostate-specific antigen (PSA) testing for prostate cancer screening, endoscopic examinations, and fecal occult blood tests for screening for colorectal cancer.

The authors, led by Ingrid J. Hall, PhD, MPH, of the CDC, assessed screening trends from the NHIS for the years 2000, 2003, 2005, 2008, 2010, 2013, and 2015.

They evaluated whether any changes had occurred in the use of cancer screening tests in the United States overall and with regard to subgroups during those years.

The authors also assessed whether any progress had been made in reducing screening disparities, which in turn should help in decreasing the nation's overall burden of cancer.

"Our analysis of the 2015 NHIS showed that halfway through the Healthy People 2020 decade, estimates for use of cervical, breast, and colorectal cancer screening tests are well below Healthy People 2020 targets," they write.

Overall, only the screening rate for colorectal cancer increased in 2015, rising to a little more than 60%.

However, this is still short of the National Colorectal Cancer Roundtable target of screening 80% of age-appropriate individuals by 2018, they point out.

The authors note that Pap testing and mammography rates showed slight declines from 2000 to 2015.

They found that Pap test screening for cervical cancer (recommended for women aged 21 to 65 years) exceeded 80%, but this is still lower than the Healthy People target of 93%.

Mammography for breast cancer screening (recommended for women aged 50 to 75 years) exceeded 70%, but, again, this falls below the Healthy People target, which is 81%.

Overall, cancer screening was lowest among uninsured persons (women, 45%; men, 49%), those with no usual source of care (women, 46%; men, 42%), those who had not consulted a physician in the past 12 months (women, 49%; men, 48%), and non-Hispanic Asians (women, 55%; men, 51%).

Women Undergoing Cancer Screening

The authors note that use of Pap testing declined significantly by 4.3% from 2000 to 2015 among women who had a usual source of care. No significant changes were noted among those without a usual source of care.

Rates of mammography also declined significantly by 3.0% from 2000 to 2015, although rates did remain relatively high throughout that period. Regarding mammography screening, there were no significant correlations between specific years, usual source of care, or insurance type.

In contrast, the rate of colorectal cancer screening among women increased significantly from 2000 to 2010 by 25.1%. The rate remained stable from 2010 to 2013, then rose slightly in 2015, for an overall increase of 28.5%. Neither sociodemographic characteristics, access to care, or recent colorectal cancer testing significantly influenced screening rates.

Cancer Screening Rates in Men

As with women, colorectal cancer screening rates in men showed a significant increase over time among all groups who had insurance, but there was variation among those with different types of insurance. The increase was greater among men with private insurance (27.2%) compared with other insurance types from 2000 through 2010. The rate dropped in 2013 but rose again in 2015, for an overall increase of 28.5%. Increases in screening rates for men using public insurance (26.5%) and among the uninsured (26.3%) were more linear in that period.

Rates for annual prostate cancer screening with the PSA test declined significantly by 9.2% from 2008 through 2013 but remained relatively stable from 2013 through 2015, dropping 4.5% overall. There were no significant correlations between sociodemographic characteristics or access to care and having recently undergone PSA testing.

No Surprises

Approached for comment, Darrell Gray, MD, MPH, a gastroenterologist at the Ohio State University Comprehensive Cancer Center, Columbus, and deputy director at the Center for Cancer Health Equity, said he was not surprised at the results of this survey.

"People who lack insurance and who have low income and no usual source of care — it's no surprise that they have a lower prevalence of screening," he said.

Gray explained that he spends a great deal of time in the community engaging with people and explaining the importance of screening. "We have to partner with the community, we need to be visible, and we need to build relationships and trust and work on initiatives that do that," he said.

The CDC article gives clues for the next steps. "It is showing us which communities may need more focus and interventions," Gray said. "And we have to better understand some of the social deteminants of health that can help us navigate beyond barriers."

One such barrier is not having insurance. Transportation is another major problem for some, as is having to take time off from work. "There are so many dynamics that are happening outside of the clinic, and we have to get out there and talk to people and engage them in an environment in which they are comfortable," he said.