National Breast and Cervical Cancer Early Detection Program data validation project.

BACKGROUND: The objectives of this study were to evaluate the quality of national data generated by the National Breast and Cervical Cancer Early Detection Program (NBCCEDP); to assess variables collected through the program that are appropriate to use for program management, evaluation, and data analysis; and to identify potential data-quality issues. METHODS: Information was abstracted randomly from 5603 medical records selected from 6 NBCCEDP-funded state programs, and 76 categorical variables and 11 text-based breast and cervical cancer screening and diagnostic variables were collected. Concordance was estimated between abstracted data and the data collected by the NBCCEDP. Overall and outcome-specific concordance was calculated for each of the key variables. Four screening performance measures also were estimated by comparing the program data with the abstracted data. RESULTS: Basic measures of program outcomes, such as the percentage of women with cancer or with abnormal screening tests, had a high concordance rate. Variables with poor or inconsistent concordance included reported breast symptoms, receipt of fine-needle aspiration, and receipt of colposcopy with biopsy. CONCLUSIONS: The overall conclusion from this comprehensive validation project of the NBCCEDP is that, with few exceptions, the data collected from individual program sites and reported to the CDC are valid and consistent with sociodemographic and clinical data within medical records.

Data and trends in cancer screening in the United States: results from the 2005 National Health Interview Survey.

BACKGROUND: This paper examines the prevalence of cancer screening use as reported in 2005 among US adults, focusing on differences among historically underserved subgroups. We also examine trends from 1992 through 2005 to determine whether differences in screening use are increasing, staying the same, or decreasing. METHODS: Data from the National Health Interview Surveys between 1992 and 2005 were analyzed to describe patterns and trends in cancer screening practices, including Papanicolaou test, mammography, prostate-specific antigen, and colorectal screening. Logistic regression was used to report 2005 data for population subgroups defined by several demographic and socioeconomic characteristics. RESULTS: Rates of use for cancer tests are rising only for colorectal cancer, due largely to the increase in colorectal endoscopy screening. Use of all the modalities was strongly influenced by contact with a physician and by having health insurance coverage. CONCLUSIONS: There remain large gaps in use for all screening modalities by education, income, usual source of care, health insurance, and recent physician contact. These specific populations would benefit from interventions to overcome these barriers to screening.

Use of additional treatment for prostate cancer after radical prostatectomy, radiation therapy, androgen deprivation, or watchful waiting.

OBJECTIVE: To examine how the use of additional treatment for prostate cancer differs as a function of the initial therapy (radical prostatectomy [RP], radiation therapy [RT], androgen deprivation therapy [ADT], or watchful waiting [WW]) for men with non-metastatic prostate cancer. MATERIAL AND METHODS: A dataset was created that combined information from the Surveillance, Epidemiology, and End Results program and Medicare claims for hospital and physician services. To identify patients receiving additional cancer treatment, we searched the claims for the presence of RP, RT (palliative radiation not included), or ADT. RESULTS: The study population consisted of 12 711 patients: as initial treatment, 3940 (31.0%) had RP, 3950 (31.1%) RT, 1209 (9.5%) ADT, and 3612 (28.4%) WW. The RP group had a less favorable distribution of tumor differentiation than the RT group. Only 54.6% of men who had initial RP had localized cancer. In men who had initial RP, 8.1% had RT and 12.4% ADT during the follow-up period, which was 6-66 months after the initial therapy ended. Among patients who had initial RT or WW, 22.8% and 22.1%, respectively had ADT during the follow-up period. CONCLUSION: Older American men with prostate cancer who are initially treated with RT or simply observed (WW) are more likely than men who undergo RP to receive ADT as a follow-up treatment.

Additional surgical intervention after radical prostatectomy, radiation therapy, androgen-deprivation therapy, or watchful waiting.

OBJECTIVES: The amount of additional surgical procedures that cancer patients undergo following their initial treatment is one means of measuring the impact that cancer and cancer treatment has on their quality of life. In this study we looked for treatment-related differences in the need for additional surgical intervention among men with nonmetastatic prostate cancer within 66 mo of their initial treatment. METHODS: Data for this study were from the National Cancer Institutes Surveillance, Epidemiology, and End Results (SEER) program and from the Medicare claims database. We searched the claims database for procedure codes indicating artificial urinary sphincter procedures, cystoscopy, urethral dilation, transurethral resection of the prostate (TURP) and bladder-neck incision, bladder irrigation/cystotomy, or nephrostomy. RESULTS: Of the 12,711 patients in our study, 3940 (31.0%) were initially treated by radical prostatectomy (RP), 3950 (31.1%) by radiation therapy (RT), 1209 (9.5%) by androgen-deprivation therapy (ADT), and 3612 (28.4%) by watchful waiting (WW). The percentage of patients who underwent cystoscopy 6-66 mo after their initial treatment ranged narrowly from 22% to 24% among members of the four treatment groups. In the RP group, 5.2% had artificial urinary sphincter procedures; 6.8% of the RT group, 8.2% of the ADT group, and 10.1% of the WW group had TURP/bladder-neck procedures compared with 3.7% of the RP group; and 12.5-16.2% of members in the four groups had urethral dilation procedures. CONCLUSIONS: Over one third of prostate cancer patients needed surgical intervention within 66 mo of their initial treatment despite the type of initial treatment.

Meeting the mammography screening needs of underserved women: the performance of the National Breast and Cervical Cancer Early Detection Program in 2002-2003 (United States).

OBJECTIVE: To examine the extent to which the National Breast and Cervical Cancer Early Detection Program (Program) has helped to meet the mammography screening needs of underserved women. METHODS: Low-income, uninsured women aged 40-64 are eligible for free mammography screening through the Program. We used data from the U.S. Census Bureau to estimate the number of women eligible for services. We obtained the number of women receiving Program-funded mammograms from the Program. We then calculated the percentage of eligible women who received mammograms through the Program. RESULTS: In 2002-2003, of all U.S. women aged 40-64, approximately 4 million (8.5%) had no health insurance and had a family income below 250% of the federal poverty level, meeting Program eligibility criteria. Of these women, 528,622 (13.2%) received a Program-funded mammogram. Rates varied substantially by race and ethnicity. The percentage of eligible women screened in each state ranged from about 2% to approximately 79%. CONCLUSIONS: Although the Program provided screening services to over a half-million low-income, uninsured women for mammography, it served a small percentage of those eligible. Given that in 2003 more than 2.3 million uninsured, low-income, women aged 40-64 did not receive recommended mammograms from either the Program or other sources, there remains a substantial need for services for this historically underserved population.

Colorectal cancer test use among Hispanic and non-Hispanic U.S. populations.

INTRODUCTION: Although colorectal cancer mortality rates in the general U.S. population declined slightly from 1992 to 2000, the rates for Hispanic men and women did not. Disparity in colorectal cancer screening among Hispanics may be an important factor in the unchanged mortality trends. This study examined rates of colorectal cancer test use among Hispanic and non-Hispanic adults in the United States. METHODS: Using sampling weights and logistic regression, we analyzed colorectal cancer test use among 5680 Hispanic and 104,733 non-Hispanic adults aged 50 years and older who participated in the 2002 Behavioral Risk Factor Surveillance System. We estimated the percentages and adjusted odds ratios (ORs) of the respondents' reported test use by sociodemographic characteristics, health care access, and state or territory of residence. RESULTS: Hispanic respondents aged 50 and older reported having had either a fecal occult blood test within the past year or a lower endoscopy (sigmoidoscopy or colonoscopy) within 10 years less frequently (41.9%) than non-Hispanic respondents (55.2%). Rates of test use were lower for respondents who reported less education, lower income, no health insurance, and no usual source of health care, regardless of Hispanic ethnicity. After adjusting for differences in education, income, insurance, and having a usual source of health care, Hispanic respondents remained less likely than non-Hispanic respondents to report colorectal cancer testing (OR for fecal occult blood test, 0.66; 95% confidence interval [CI], 0.56-0.81; OR for lower endoscopy, 0.87; 95% CI, 0.77-0.99). Greater disparity in screening rates between Hispanics and non-Hispanics was observed in Colorado, California, and Texas than in other states. CONCLUSION: A disparity exists between Hispanic and non-Hispanic U.S. adults in colorectal cancer test use. This disparity varies among the states, highlighting the diverse health care experience of Hispanic adults in the United States.

Breast cancer screening among low-income or uninsured women: results from the National Breast and Cervical Cancer Early Detection Program, July 1995 to March 2002 (United States).

OBJECTIVE: To describe the results of breast cancer screening among low-income and uninsured women in the only national organized screening program in the US, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). METHODS: We analyzed mammography and diagnostic follow-up data for 789,647 women who received their first mammogram in the NBCCEDP and 454,754 subsequent mammograms among these women. We calculated the rate of mammograms with abnormal findings, diagnostic follow-up, biopsy, and cancers detected per 1000 mammograms by age and racial or ethnic groups. Positive Predictive Values (PPVs) were estimated for abnormal mammograms and biopsy. RESULTS: Nearly 64% of the women screened in the program were from 50 to 64 years of age and about 46% were members of racial or ethnic minority groups. Women aged 40 to 49 years had the highest rates of abnormal mammograms and of diagnostic follow-up. However, cancer detection rates were highest in women aged 60 to 64 years. In addition, the PPVs for both abnormal mammograms and biopsy were highest in the oldest age group. CONCLUSIONS: Cancer detection rates and PPVs for both abnormal mammograms and biopsy were highest in women aged 50 years or more. These results support the programs focus on screening women aged 50 and older for breast cancer.

Are older adults up-to-date with cancer screening and vaccinations?

INTRODUCTION: Public health organizations in the United States emphasize the importance of providing routine screening for breast cancer, cervical cancer, and colorectal cancer, as well as vaccinations against influenza and pneumococcal disease among older adults. We report a composite measure of adults aged 50 years and older who receive recommended cancer screening services and vaccinations. METHODS: We analyzed state data from the 2002 Behavioral Risk Factor Surveillance System, which included 105,860 respondents aged 50 and older. We created a composite measure that included colonoscopy or sigmoidoscopy within 10 years or a fecal occult blood test in the past year, an influenza vaccination in the past year, a Papanicolaou test within 3 years for women with an intact cervix, a mammogram, and for adults aged 65 and older, a pneumonia vaccination during their lifetime. We performed separate analyses for four age and sex groups: men aged 50 to 64, women aged 50 to 64, men aged 65 and older, and women aged 65 and older. RESULTS: The percentage of each age and sex group that was up-to-date according to our composite measure ranged from 21.1% of women aged 50 to 64 (four tests) to 39.6% of men aged 65 and older (three tests). For each group, results varied by income, education, race/ethnicity, insurance status, and whether the respondent had a personal physician. CONCLUSION: These results suggest the need to improve the delivery of cancer screenings and vaccinations among adults aged 50 and older. We propose continued efforts to measure use of clinical preventive services.

Prostate-specific antigen test use reported in the 2000 National Health Interview Survey.

BACKGROUND: In 2000, the National Health Interview Survey (NHIS) collected information about prostate-specific antigen (PSA) test use in a representative sample of U.S. men. METHODS: This study examined PSA test use in subgroups defined by personal and social characteristics. RESULTS: Among men aged 50 and older with no history of prostate cancer, 56.8% reported ever having had a PSA test, 34.1% reported having had a screening PSA test during the previous year, and 30.0% reported having had three or more tests during the previous 5 years. Screening was greater among men aged 60-79 years, those with greater access to care, and those practicing other preventive behaviors. Among men in their 40s, use tended to be higher among African-American men. CONCLUSIONS: The prevalence and patterns of PSA screening suggest that PSA is used like other cancer screening tests among about a third of U.S. men. Because of the lack of scientific consensus on whether prostate cancer screening is beneficial, more information is needed on how knowledgeable both patients and practitioners are about the potential benefits and harms of screening and how prostate cancer screening decisions are made.

Cervical screening in the National Breast and Cervical Cancer Early Detection Program, 1995-2001.

OBJECTIVE: To describe results of cervical cytology screening among low-income and uninsured women in the National Breast and Cervical Cancer Early Detection Program. METHODS: We analyzed data from 750,591 women who received their first Papanicolaou (Pap) test in the program between July 1995 and March 2001. RESULTS: Nearly 85% of the women were aged 40 years or older. Almost half were members of racial or ethnic minority groups. Overall, the percentage of abnormal Pap test results decreased with increasing age. The rates of cervical intraepithelial neoplasia (CIN) were highest in the younger age groups but the rate of invasive cancer increased with age. White women had the highest age-adjusted percentage of abnormal Pap test results and the highest rate of biopsy-confirmed CIN 2 or worse. CONCLUSIONS: In this nationwide screening program, only 7% of all biopsy-confirmed high-grade cervical lesions (CIN 2 or worse) were invasive cancer. This underscores the success of Pap screening in identifying preinvasive disease and preventing cancer. LEVEL OF EVIDENCE: II-3

Are people being screened for colorectal cancer as recommended? Results from the National Health Interview Survey.

BACKGROUND: The evidence is now compelling that colorectal cancer incidence and mortality can be reduced by screening, and medical organizations recommend regular screening among persons of average risk aged 50 years or older. We sought to determine whether appropriate screening has become more widespread now that consensus over its value has been achieved. METHODS: We analyzed data from the 1992 and 1998 National Health Interview Survey, an in-person survey of a nationally representative sample of the U.S. population. Persons aged > or =50 years (4428 in 1992, 12,629 in 1998) were questioned about their use of colorectal cancer screening. RESULTS: Self-reported use of fecal occult blood testing and proctoscopy increased slightly from 1992 to 1998. In 1998, however, only an estimated 22.9% of Americans aged > or =50 years had been screened with either the home-administered fecal occult blood testing in the past year or proctoscopy within 5 years. Nearly half of fecal occult blood testings were performed with a sample taken during an in-office physical examination rather than with the recommended home kit. CONCLUSION: Most eligible persons are still not meeting the screening recommendations for colorectal cancer. Education is needed for both the public and health care providers to increase their compliance with current guidelines.