Screening methods and programs are critical strategies for the early detection and timely treatment of some cancers. Established methods for early detection of cancer include mammography, clinical breast examination (CBE), the Papanicolaou (Pap) test, proctosigmoidoscopy, fecal occult blood test (FOBT), and digital rectal examination (DRE). To examine changes in the reported use of selected cancer screening tests, the National Cancer Institute analyzed data from CDC's National Health Interview Survey (NHIS) for 1987 and 1992 to calculate rates of use and compared these rates with the national health objectives for the year 2000. This analysis suggests that, although the use of these tests increased, substantial progress is needed to meet the objectives.
The NHIS is a continuing nationwide household survey that collects information from a representative sample of the US civilian, non institutionalized population age equal to or more than 18 years. The overall response rate for the 1987 and 1992 surveys was 95.3% (N = 122,859) and 95.7% (N = 128,412), respectively. In 1987 and 1992, questions were included to determine respondents' knowledge and practices regarding cancer screening. Respondents were asked whether they had ever had a Pap test, CBE, mammography, DRE, FOBT, or proctosigmoidoscopy. Respondents who answered "yes" to any of the questions were asked when their most recent test had been performed. Screening tests were defined as tests performed for any reason other than as the result of a health problem.
For CBE, mammography, DRE, and FOBT, screening was considered recent if it had been performed during the year preceding the interview; for the Pap test and proctosigmoidoscopy, within the preceding 3 years. Data about CBE and mammography are presented for women age equal to or more than 40 years; for DRE, FOBT, and proctosigmoidoscopy, persons age equal to or more than 40 years, and for the Pap test, women age equal to or more than 18 years with an intact uterus.
From 1987 to 1992, the overall percentage of women age equal to or more than 18 years who re-ported having had a recent Pap test remained stable (Table 1). The percentage increased slightly for Hispanic women, and remained low for women aged equal to or more than 70 years.
The increase in the percentage of women ever tested was greater for women aged equal to or more than 50 years (85% to 89%) than women aged equal to or more than 50 years (90% to 92%), and for black (88% to 92%) and Hispanic women (75% to 83%) than white women (91% to 92%).
During this period, the percentage of respondents who reported recent mammography increased at least twofold for women in every age and racial/ethnic group. The greatest increases were for black and Hispanic women; as a consequence, in 1992, screening rates were similar for white, black, and Hispanic women. However, women age equal to or more than 70 years in 1992 remained less likely to have had a recent screening and to have ever been tested than women age less than 70 years. From 1987 to 1992, the percentage of respondents who reported having had a recent CBE also increased; in 1992, at least 75% of women in each age group reported ever having the test.
From 1987 to 1992, the percentage of respondents who reported ever having had a DRE increased from 49% to 54% for men and from 51% to 54% for women. Although increases were greater for men than women, rates for recent DRE were lower for men than women (22% vs 21% in 1992). Rates of recent FOBT remained stable; however, the rate for black men increased more than twofold, from 7% to 15%. The overall percentages of respondents who reported ever having had proctosigmoidoscopy increased for men (24% to 30%) and for women (21% to 26%), and the percentage screened recently was higher for men than women in both 1987 and 1992 (7% and 11%, respectively, vs 5% and 7%, respectively).
Editorial Note From the CDC
The analysis described in this report estimates use of cancer screening tests based on a representative sample of the US population, and four of these tests have been targeted as national health objectives for the year 2000 (objectives 16.11-16.14). Although the findings indicate an increase in the recent use of all cancer screening tests (except the Pap test) from 1987 to 1992, percentages are substantially lower than the national objectives. For example, one objective is to increase the rate of mammography among women age equal to or more than 50 years to 60% every 2 years and among women age equal to or more than 40 years to 80% ever (objective 16.11). Based on this survey, the rate of recent mammography among women age equal to or more than 50 years was 44% in 1992 and ever having had mammography was 70% for women age equal to or more than 40 years.
The differences in the screening rates and the national health objectives may, in part, reflect for respondents a lack of (1) health insurance coverage, (2) a primary-care physician, or (3) clear communication between physicians and patients about the importance of routine screening. For example, the lower rate of mammography use by women age equal to or more than 50 years (who are at greatest risk for breast cancer) may reflect the finding that these women are less likely to visit gynecologists, and of all physician specialists, gynecologists are most likely to recommend mammograms. In addition, for women with low incomes, the mammography objectives are unlikely to be met because facilities that perform mammography may not accept women without a referral from a primary-care physician, and a disproportionate number of women with low incomes do not have a regular health-care provider. To promote mammography screening among older women, since 1990, Medicare has reimbursed the cost of biennial mammograms. Although the reimbursement fee is substantially less than the median price of mammograms in the US, the fee is feasible if mammograms are delivered using more efficient methods and established mass-production techniques.
In the United States, managed care and the increased use of health maintenance organizations (HMOS) are likely to increase the use of all preventive-care services (including screening examinations), particularly if primary-care physicians are encouraged to screen patients routinely and recommend screening tests they currently do not perform. In addition, however, the importance of some screening examinations, such as the Pap test, may need to be emphasized regularly in public health messages.
Reported by: N. Breen, PhD, L. Kessler , PhD, Applied Research Br., NCI, NIH, Div.of Cancer Prevention and Control, National Center for Cronic Disease Prevention and Health Promotion; National Center for Health Statistics, CDC.
Adopted from Morbidity and Mortality Weekly Report, vol 45, no. 3, 1995