This is bittersweet. According to Preventing Chronic Disease magazine and the NCI, "From 2008 to 2010, overall rates of breast and cervical cancer screening slightly decreased, but screening rates for colorectal cancer rose by 7 percentage points." Although it saddens me that screening for breast and cervical cancer have fallen, I'm so happy that colon cancer screenings have risen by 7% from 2008-2010.
Please don't ever forget how important all screening are to a healthy living. Don't be scared!
I got you.
-- Dr. Dale
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Cancer Screening Rates Fall Below CDC Target Goals
Roxanne Nelson
March 05, 2014When it comes to cancer screening, the Healthy People initiative is short of meeting its targets, particularly for certain population subgroups.
From 2008 to 2010, overall rates of breast and cervical cancer screening slightly decreased, but screening rates for colorectal cancer rose by 7 percentage points.
The rates of cancer screening and counseling by healthcare providers were also below designated targets.
The report was published in the February issue of Preventing Chronic Disease.
"Our report tracks established Healthy People objectives," said report author Carrie N. Klabunde, PhD, an epidemiologist in the Health Services and Economics of the National Cancer Institute (NCI). "There are Healthy People objectives and target screening rates for breast, cervical, and colorectal cancer screening, all of which are recommended by the US Preventive Services Task Force."
However, Healthy People does not have a target screening rate for prostate cancer screening, she told Medscape Medical News.
"The Healthy People developmental objective is consistent with current US Preventive Services Task Force and other guidelines that advise doctor–patient discussions and informed decision-making on whether or not to undergo PSA testing," Dr. Klabunde explained.
The NCI and Centers for Disease Control and Prevention focus their cancer screening monitoring activities on the screening types and tests that are evaluated by the US Preventive Services Task Force, which is administered by the Agency for Healthcare Research and Quality, she added.
Healthy People is a program of nationwide health-promotion and disease-prevention goals, which are set by the US Department of Health and Human Service. The current report provides data from the National Health Interview Survey (NHIS), which is used for setting and evaluating several of the Healthy People targets in cancer.
Dr. Klabunde and her colleagues compared several Healthy People 2020 goals, including cancer screening and healthcare provider counseling, with established 2020 targets.
Breast and Cervical Cancer Screening Declines
For breast cancer screening, the Healthy People 2020 target goal is 81.1%. Overall, the proportion of women who reported getting a mammogram from 2008 to 2010 declined, but it was not significant. However, there were differences in the various segments of the population. Non-Hispanic blacks, non-Hispanic Asians, and women with public health insurance all showed decreases in screening, but in this time period, the changes were not significant.
Conversely, in 2010, women in the highest-income group exceeded the target goal of 81.1%, and the overall population and 7 designated subgroups fell within 10 percentage points of this target. But women lacking health insurance, those without a source of usual care, and those whose incomes fell below 200% of the federal poverty level were at least 20 percentage points below the target.
The decline in cervical cancer screening was more pronounced. In the same time period, cervical cancer screening overall declined significantly by 1.5 percentage points (P = .0479). There were also small nonsignificant decreases in most subgroups.
The researchers note that there were modest increases in screening for those without a source of usual care and non-Hispanic Asians — the 2 groups that had shown some of the lowest screening levels in 2008.
In 2010, the overall population, non-Hispanic whites, non-Hispanic blacks, those with private health insurance, and those with a usual source of care fell within 10 percentage points of the target screening goal of 93.0%. Women with the highest incomes (at or above 400% of the federal poverty level) were within 2 percentage points of the target, at 91.4%.
As with breast cancer screening, those lacking insurance and a usual source of care were at least 20 percentage points below the target.
Colorectal Cancer Screening Goes Up
In contrast to breast and cervical cancer screening, more people are getting screened for colorectal cancer. For the population as a whole, there was a significant increase of 7 percentage points from 2008 to 2010, and screening rates increased significantly for nearly all subgroups (except non-Hispanic Asians and the uninsured).
Although the screening goal of 70.5% wasn't met by any group, 4 subgroups (non-Hispanic whites, those with incomes at or above 400% of the federal poverty level, those with private health insurance, and those with a usual source of care) came within 10 percentage points of it. Conversely, as with the other types of cancer screening, individuals lacking insurance, those with incomes less than 200% of the federal poverty level, and those without a usual source of care were at least 20 percentage points below the target. The same was true for Hispanics and non-Hispanic Asians.
Counseling and Genetic Screening
According to 2010 estimates, 53.9% of women 21 to 65 years of age who underwent Pap testing in the previous 3 years also reported receiving a physician recommendation. This falls short of the 66.2% target. Similarly, 59.5% of women 50 to 74 years of age reported receiving a recommendation for a mammogram in the previous 12 months, which also fell short of the 76.8% target.
For mammograms and Pap tests, those without insurance or a usual source of care were furthest from the target rates.
Rates for genetic counseling for breast or ovarian cancer appear to have risen, from about 35% of eligible women in 2005 to nearly 60% in 2010. However, because of the small sample sizes, a trend toward increasing percentages cannot be confirmed, the researchers write. The 2020 target is 38.1%.
Dr. Klabunde and her colleagues point out that because counseling for PSA testing was a developmental objective for Healthy People 2020, no target was set. NHIS 2010 data indicate that 39.7% of men 50 to 74 years of age had received counseling about PSA testing, and counseling rates were slightly higher for men with higher incomes or private insurance. Conversely, they were quite low for men lacking health insurance or a usual source of care.
Prev Chronic Dis. 2014;11:130174. Abstract
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Cite this article: Cancer Screening Rates Fall Below CDC Target Goals. Medscape. Mar 05, 2014.
