Abstract
BackgroundU.S. cancer screening guidelines communicate important information regarding the ages for which screening tests are appropriate. Little attention has been given to whether breast, colorectal and prostate cancer screening test use is responsive to guideline age information regarding the age of screening initiation.MethodsThe 2006 Behavioral Risk Factor Social Survey and the 2003 National Health Interview Surveys were used to compute breast, colorectal and prostate cancer screening test rates by single year of age. Graphical and logistic regression analyses were used to compare screening rates for individuals close to and on either side of the guideline recommended screening initiation ages.ResultsWe identified large discrete shifts in the use of screening tests precisely at the ages where guidelines recommend that screening begin. Mammography screening in the last year increased from 22% [95% CI = 20, 25] at age 39 to 36% [95% CI = 33, 39] at age 40 and 47% [95% CI = 44, 51] at age 41. Adherence to the colorectal cancer screening guidelines within the last year increased from 18% [95% CI = 15, 22] at age 49 to 19% [95% CI = 15, 23] at age 50 and 34% [95% CI = 28, 39] at age 51. Prostate specific antigen screening in the last year increased from 28% [95% CI = 25, 31] at age 49 to 33% [95% CI = 29, 36] and 42% [95% CI = 38, 46] at ages 50 and 51. These results are robust to multivariate analyses that adjust for age, sex, income, education, marital status and health insurance status.ConclusionThe results from this study suggest that cancer screening test utilization is consistent with guideline age information regarding the age of screening initiation. Screening test and adherence rates increased by approximately 100% at the breast and colorectal cancer guideline recommended ages compared to only a 50% increase in the screening test rate for prostate cancer screening. Since information regarding the age of cancer screening initiation varies across countries, results from this study also potentially have implications for cross-country comparisons of cancer incidence and survival statistics.
Highlights
U.S cancer screening guidelines communicate important information regarding the ages for which screening tests are appropriate
(page number not for citation purposes) http://www.biomedcentral.com/1472-6963/9/185 within the previous year, 52% of women and men ages 50-64 received either a home fecal occult blood test (FOBT) within the past year year or a sigmoidoscopy or a colonoscopy within the past 5 years, and 54% of men ages 50-64 received a prostate specific antigen (PSA) test within the previous year. We extend this line of research by explicitly evaluating whether breast, colorectal, and prostate cancer screening test rates are consistent with guideline age information
One issue to note regarding the difference between the age 40 and age 41 screening rates is that not everyone who is 40 years old has been at the recommended screening age for an equivalent amount of time. This is because the screening measure used in the Behavioral Risk Factor Surveillance System (BRFSS) is "screened in the past year", which means that women who turned 40 years of age close to the BRFSS interview date have spent little time in the recommended screening age
Summary
U.S cancer screening guidelines communicate important information regarding the ages for which screening tests are appropriate. Little attention has been given to whether breast, colorectal and prostate cancer screening test use is responsive to guideline age information regarding the age of screening initiation. Cancer screening tests are available for detecting breast, colorectal, and prostate cancers. For breast cancer, randomized control trials and observational studies show that mammography screening reduces mortality [1,2]. A recent compendium of micro-simulation modeling studies has produced a lower bound estimate of 28% for the role of mammography screening in reducing U.S breast cancer mortality over the 1975-2000 time period[2]. Randomized control trials show that the fecal occult blood test (FOBT) reduces colorectal cancer mortality by 16% [3]. Randomized control trial evidence on the health benefits from the use of the PSA screening test has only recently become available [4,5]. The European trial [5] found a 20% reduction in mortality (9 year median follow up) from PSA screening but the U.S trial [4] did not find any differences in 7 to 10 year mortality between the treatment and control groups
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