Use Of Cancer Screening Services Research Articles

Trends in socioeconomic inequalities in cervical, breast, and colorectal cancer screening participation among women in Japan, 2010–2019

BackgroundIt is known that socioeconomic status (SES) influences the outcome of cancer treatment and this could partly be explained by decreased use of cancer screening services by people of lower SES. Many studies have indicated that low SES, including low educational attainment or unstable employment, was related to nonparticipation in cancer screening. However, studies investigating trends in SES inequalities within cancer screening participation are limited. Our objective was to examine trends in SES inequalities in cervical, breast, and colorectal cancer screening participation among women in Japan between 2010 and 2019. MethodsWe analyzed 189,442, 168,571, 163,341, and 150,828 women in 2010, 2013, 2016, and 2019 respectively, using nationally representative cross-sectional surveys. The main outcome variables are participation in each cancer screening. We used educational attainment and employment status as measures for SES. Multivariable logistic regression analysis, adjusted for age, marital status, educational attainment, and employment status was performed to evaluate the associations between SES and nonparticipation in each cancer screening. ResultsOverall participation rates in each cancer screening increased between 2010 and 2019. Low educational attainment and non-permanent employment status were related to nonparticipation in each cancer screening and inequality according to employment status increased within each screening participation during the study period. For example, dispatched workers were more likely to not participate in cervical cancer screening than permanent workers: in 2010, [aOR 1.11 95 %CI: 1.01 –1.21], and in 2019, [aOR 1.46 95 %CI: 1.34–1.60]. The inequality was greatest in colorectal cancer screening nonparticipation, followed by breast and cervical screening. ConclusionsAlthough the participation rates in each cancer screening have increased, inequality in participation in terms of employment status widened among women in Japan between 2010 and 2019. Reducing inequalities in cancer screening participation is essential for cancer screening intervention policies.

The association between cigarette smoking, cancer screening, and cancer stage: a prospective study of the women’s health initiative observational cohort

ObjectiveTo assess the dose-dependent relationship between smoking history and cancer screening rates or staging of cancer diagnoses.DesignProspective, population-based cohort study.SettingQuestionnaire responses from the Women’s Health Initiative (WHI) Observational Study.Participants89 058...

Is Cancer Screening a Priority among Adult Females in Sri Lanka?

We assessed the use of well women clinics (WWC) screening services for cervical and breast cancer prevention in a sample of females attending the largest religious festival in Sri Lanka. Of the 3,116 women studied, 2, 874(92.2%) were aware on breast cancer and 2, 609(83.7%) on cervical carcinoma. Of them only 1,895 (60.8%) were aware of the WWC services, but only 578 (18.5%) had ever used the services. Of the 217 professionals or associate professionals in the study sample, 190 (87.6%) were aware of the WWC compared to only 58.8% among the 2,899 women falling under the categories of other occupations and housewives. Clinic attendance was also significantly higher amongst professionals and associate professionals compared to women in other occupational categories and housewives (40.1% versus 16.9%). Use of cancer screening services are low and new strategies needed to improve the secondary prevention of these cancers in Sri Lanka.

Cancer screening service utilization and willingness-to-pay of urban populations in China: a cross-sectional survey from potential service demander's perspective

Objective: To explore the sustainability of cancer screening strategy from potential demander's perspective in Chinese country, we conducted a study on the use of cancer screening services and willingness-to-pay among the urban community residents. All the participants of this study had not been on the Cancer Screening Program in Urban China (CanSPUC) or any other national level cancer screening projects. Methods: Target communities and populations were selected from the 16 project provinces in China which were on the program between 2014 and 2015, by using the multi-center cross-sectional convenience sampling method. Chi-square was used to compare the rates on the utilization of service and willingness-to-pay across the different subgroups. Logistic progression was conducted to examine factors that associated with the service utilization and willingness-to-pay. Results: A total of 16 394 participants were included in this study. Among them, 12.1% (1 984/16 394) had ever been on a cancer screening program. Populations with following characteristics as: being elderly (60-69 years, OR=1.27, 95% CI: 1.13-1.43), female (male, OR= 0.56, 95%CI: 0.50-0.62), having had higher education (high school/specialized secondary school, OR= 1.51, 95%CI: 1.35-1.70; college or over, OR=2.10, 95%CI: 1.36-3.25), working for public (OR=2.85, 95% CI: 2.26-3.59), enterprises or self-employed agencies (OR=1.32, 95% CI: 1.06-1.64), having higher income (60 000-150 000 Chinese Yuan, OR=1.55, 95%CI: 1.39-1.73; ≥150 000 Chinese Yuan, OR=2.57, 95% CI: 2.09-3.15), under basic medical insurance programs for urban employees/for government servants'(OR=1.15, 95% CI: 1.01-1.32), on basic medical insurance set for urban residents'/on commercial medical insurance programs etc. (OR=1.01, 95%CI: 0.84-1.22), were in favor of the services. When neglecting the fee for charge, 65.8% (10 795/16 394) of the participants said that they could accept the cancer screening program, particularly in those who had already been on the screening program (P<0.05). 61.2% (10 038/16 392) of all the participants showed the willingness-topay for a long-term packaging screening services, particularly in those who were relatively younger (60-69 years, OR=0.80, 95%CI: 0.74-0.87), working for public (OR=1.76, 95%CI: 1.56-1.98) or enterprise sectors or self-employed households (OR=1.32, 95%CI: 1.18-1.47), having higher income (60 000-150 000 Chinese Yuan, OR=1.51, 95%CI: 1.40-1.63; ≥150 000 Chinese Yuan,OR= 1.95, 95% CI: 1.60-2.38), utilized screening services (OR=2.18, 95% CI: 1.94-2.46). Conclusions: The rate of using the cancer screening services should be improved. Factors including age, gender, education, occupation, income and insurance appeared as major factors related to the use of cancer screening services. Willingness-to-pay seemed relatively high, but the amount of payment they could afford was limited. Factors including age, occupation, income and insurance appeared as major factors to the willingness-to-pay.

Cancer Screening Among Peer-Led Community Wellness Center Enrollees.

Growing evidence suggests health disparities exist in services for individuals with mental disorders served by the public mental health system. The current study assessed the use of cancer screening services among New Jersey residents in publicly funded mental health programs. Self-administered written surveys were completed by 148 adults using peer-led community wellness centers throughout New Jersey. Information was collected on (a) the use of breast, cervical, and colorectal cancer screening services; (b) barriers to receiving preventive services; and (c) perceptions of overall health. More males than females participated in the study, with equal participation among White and African American individuals. Schizophrenia spectrum disorders were the most common self-reported psychiatric condition. Colorectal cancers had lower screening levels compared to those of the general population. Physicians not advising patients to complete tests emerged as a main cause of low screening rates. Wellness initiatives designed by peers collaborating with health care providers may improve adherence to preventive cancer screening measures.

The impact of Medicare eligibility on cancer screening behaviors

IntroductionLack of health insurance limits access to preventive services, including cancer screening. We examined the effects of Medicare eligibility on the appropriate use of cancer screening services in the United States. MethodsWe performed a cross-sectional analysis of the 2012 Behavioral Risk Factor and Surveillance System (analyzed in 2014). Univariable and logistic regression analyses were performed for participants aged 60–64 and 66–70 to examine the effects of Medicare eligibility on prevalence of self-reported screening for colorectal, breast, and prostate cancers. Sub-analyses were performed among low-income (<$25,000 annual/household) individuals. ResultsMedicare-eligible individuals were significantly more likely to undergo all examined preventive services (colorectal cancer OR: 1.90; 95% CI 1.79–2.04; prostate cancer OR: 1.29; 95% CI 1.17–1.43; breast cancer OR: 1.23; 95% CI 1.10–1.37) and the effect was most pronounced among low-income individuals (colorectal cancer OR: 2.04; 95% CI 1.8–2.32; prostate cancer OR: 1.39; 95% CI 1.12–1.72; breast cancer OR: 1.42, 95% CI 1.20–1.67). Access to a healthcare provider was the strongest independent predictor of undergoing appropriate screening, ranging from OR 2.73 (95% CI 2.20–3.39) for colorectal cancer screening in the low-income population to OR 4.79 (95% CI 3.95–5.81) for breast cancer screening in the overall cohort. The difference in screening prevalence was most pronounced when comparing Medicare-eligible participants to uninsured Medicare-ineligible participants (+33.2%). ConclusionsMedicare eligibility impacts the prevalence of cancer screening, likely as a result of increased access to primary care. Low-income individuals benefit most from Medicare eligibility. Expanded public insurance coverage to these individuals may improve access to preventive services.

The role of knowledge, language, and insurance in endorsement of cancer screening in women of African origin

BackgroundAfrican women have lower use of cancer screening services compared to women born in the United States yet empirical data are limited about their cancer screening attitudes. ObjectiveTo examine factors that are associated with higher endorsement of screening. MethodWe conducted a cross-sectional study of 200 women of African origin recruited via community-based outreach activities in Washington, DC. Endorsement of screening was assessed via self-report. The primary independent variables were cancer knowledge and English-language proficiency. Information was also collected about access, cancer-related beliefs, and prior breast screening behaviors. ResultsMost participants (60%) were ≥40years of age, 54% were married, and 77% were insured. Participants more likely to endorse breast cancer screening were insured (vs. uninsured) (odds ratio=3.37; 95% confidence interval: 1.24, 9.17) and married (odds ratio=3.23; 95% confidence interval: 1.14, 9.10) controlling for other factors. The likelihood of endorsing screening was higher among participants with English as a primary language (odds ratio=3.83; 95% confidence interval: 1.24, 11.87) and those with greater breast cancer knowledge (odds ratio=1.04; 95% confidence interval: 1.01, 1.08, per 1 point increase). ConclusionsAverage cancer knowledge in the sample was low as were non-conventional causes of cancer. Study results highlight the importance of improving cancer knowledge and reducing barriers related to language and insurance. Future studies are needed to consider nuances among diverse women of African origin.

Cervical cancer: barriers to screening in the Somali community in Minnesota.

This study examined barriers to and facilitators of cervical cancer screening among Somali immigrant women in Minnesota. We adopted the socioecological framework to illustrate screening barriers at multiple levels. We conducted 23 semi-structured key informant interviews and used a thematic exploratory approach to analyze the data. Barriers were classified into individual, community or health systems levels. Obstacles included lack of knowledge, religious beliefs, fatalism, fear, embarrassment, and lack of trust in the interpreters. Participants described a need for training of healthcare providers on issues surrounding Somali women's cultural practices and sexual health. Identifying individual, community, or health system barriers and addressing them concurrently may increase use of cancer screening services among Somali women. Future interventions need to address multilevel barriers with multilevel approaches to improve utilization of cervical cancer screening services in underserved immigrant populations in the United States.

Religious beliefs and cancer screening behaviors among Catholic Latinos: implications for faith-based interventions.

Although most U.S. Latinos identify as Catholic, few studies have focused on the influence of this religious tradition on health beliefs among this population. This study explores the role of Catholic religious teachings, practices, and ministry on cancer screening knowledge, attitudes, and behaviors among Latinos. Eight focus groups were conducted with 67 Catholic Latino parishioners in Massachusetts. Qualitative analysis provided evidence of strong reliance on faith, God, and parish leaders for health concerns. Parishes were described as vital sources of health and social support, playing a central role in the community's health. Participants emphasized that their religious beliefs promote positive health behaviors and health care utilization, including the use of cancer screening services. In addition, they expressed willingness to participate in cancer education programs located at their parishes and provided practical recommendations for implementing health programs in parishes. Implications for culturally appropriate health communication and faith-based interventions are discussed.

Examining regional variation in the use of cancer screening in Germany

The detection of cancer in its early latent stages can improve a patient's chances of recovery and thereby reduce the overall burden of the disease. Cancer screening services are, however, only used by a small part of the population and utilization rates vary widely amongst the 402 German districts. This study examines to which extent geographic variation in the use of cancer screening can be explained by accessibility of these services and by spillover effects between adjacent areas, while controlling for a wide range of covariates. District level data on cancer screening utilization rates were calculated for breast, cervical, prostate, skin, and colorectal cancers using German data provided by the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung – KBV) between 2008 and 2011. We estimated the impact of health service variables on cancer screening utilization using spatial and non-spatial regression models. Spatial autocorrelation in the residuals was estimated using Moran's I statistic. After controlling for socioeconomic and other regional covariates, screening rates for breast, prostate, skin, and colorectal cancers are significantly higher in areas with higher physician density. The utilization of Pap-tests, skin cancer screening and colonoscopies is inversely related with average travel time to physicians. The coefficients for the spatial lag are significant and positive in all models. The positive spatial lags indicate that screening utilization rates are determined by knowledge spillovers between neighboring districts. In terms of public policy, our study demonstrates the potential to increase the use of cancer screening services through improving knowledge regarding cancer screening and by ensuring patient access to cancer screening services.

Socio-economic disparities in behavioural risk factors for cancer and use of cancer screening services in Korean adults aged 30 years and older: The Third Korean National Health and Nutrition Examination Survey, 2005 (KNHANES III)

To estimate the current status of cancer-related health disparities in cancer risk factors and the use of cancer screening services by Korean adults. Cross-sectional survey study. The disparities of behavioural cancer risk factors and use of cancer screening services according to equivalent monthly household income were evaluated, using multivariate logistic regression analysis, among 6466 subjects aged ≥30 years and who completed the health promotion knowledge, attitude and practice survey, which is part of the Third Korean National Health and Nutrition Examination Survey. In men, smoking (P for trend = 0.05) and physical inactivity (P for trend = 0.05) were more common in the lower-income group, while high-risk drinking (P for trend <0.01) was more common in the higher-income group. In women, physical inactivity (P for trend <0.01) was more common in the lower-income group, while smoking and high-risk drinking showed no income disparities. Income disparities were also found in the degree of participation in cancer screening programmes. Men in the highest income quintile underwent more screening for both colorectal and gastric cancer than men in the lowest income quintile and men in the second to fourth income quintiles (P for trend <0.01 for both). Women in the highest income quintile underwent more screening for cervical (P for trend <0.01) and gastric (P for trend = 0.04) cancer, while income disparities were not seen for participation in colorectal or breast cancer screening. In order to decrease behavioural risk factors and promote participation in cancer screening programmes, more targeted efforts are needed for cancer prevention among lower-income Koreans.

Use of cancer screening services in Greece and associated social factors: results from the nation-wide Hellas Health I survey

This study estimated the rates of age-appropriate screening practices for breast, cervical, colon and prostate cancer within the general population in Greece and explored the influences of social factors on their use. Data were based on the cross-sectional Hellas Health I survey (2006) conducted on a representative sample of 1005 adults, aged 18-69 years. The percentage of women aged 21-69 years having received the papanicolaou smear test within the past 3 years was 59.4%, and the percentage of women aged 50-69 years having received mammography and the faecal occult blood test (FOBT) within the past 3 years was 53.8 and 8.3%, respectively. There were significant effects of age, education and marital status on carrying out the papanicolaou smear test, age on carrying out mammography, and existence of a family doctor on carrying out the FOBT. In men aged 50-69 years, 40.6% had received the prostate-specific antigen test and 10.9% of men had received the FOBT during the past 3 years. The percentage of men aged 50-69 years who had undergone digital rectal examination within the past 5 years was 20.3%. Multivariate analyses showed significant effects of age, social class, smoking status and type of insurance on carrying out the prostate-specific antigen test and of age on carrying out the digital rectal examination. No effects were revealed for the FOBT in men. The percentage of the population in Greece receiving screening services recommended by the European Council is low and seriously affected by social factors. Public health policies should direct their efforts towards introducing good-quality universal cancer screening and find culturally sensitive ways of addressing the barriers that prevent Greek people from adopting poor-quality cancer screening practices.

Use of Cancer-Screening Services Among Persons With Serious Mental Illness in Sacramento County

This study examined the use of breast, cervical, colorectal, and prostate cancer-screening services by persons with serious mental illness enrolled in the Sacramento County Mental Health clinics. Of 387 outpatients approached from January 2005 to May 2007, 229 were interviewed. Whereas 97% of the women had received cervical cancer screening at least once in their lifetime, more than 50% of eligible persons over age 50 had never received colorectal cancer screening. Recent use of screening services was highest for cervical cancer (69% had had a Pap test in the past three years) and lowest for colorectal cancer (12% had had a fecal occult blood stool test in the past year or a flexible sigmoidoscopy or colonoscopy in the past five years). Among persons with serious mental illness, lifetime screening of cervical cancer was higher than for breast, prostate, and colorectal cancers. Receipt of routine, timely cancer screening was low, especially for colorectal cancer.

Use of Cancer-Screening Services Among Persons With Serious Mental Illness in Sacramento County

Use of Cancer-Screening Services Among Persons With Serious Mental Illness in Sacramento County

Language and Use of Cancer Screening Services among Border and Non-Border Hispanic Texas Women

Objectives. Compared to other groups, Mexican American women screen less frequently for cervical and breast cancer. The most significant barriers reported by previous researchers include not having a usual source of care, lacking health insurance and English-language difficulties. In this paper we document and examine the factors associated with disparities in cancer screening between border and non-border residents by language of interview (Spanish or English) among Texas Hispanic women. We hypothesize that, controlling for socioeconomic and demographic characteristics, border residents are more likely to utilize screening services than non-border residents because of the greater presence of bilingual services in border counties. Design. We follow the framework of the Behavioral Model for Vulnerable Populations proposed by Gelberg et al. (Health Services Research, vol. 34, no. 6, pp. 1273–1302, 2000). This model conceptualizes use of health care as an outcome of the interplay of predisposing, enabling and need factors and recognizes that vulnerable groups face additional barriers to health care utilization. Data come from the 2000, 2002 and 2004 Texas Behavioral Risk Factor Surveillance surveys. Results. Group differences in cancer screenings are explained largely by socioeconomic characteristics and structural barriers to access. The significance of language of interview and of border residence disappear after controlling for factors such as health insurance, income and a usual source of care. Conclusion. Women who selected to be interviewed in Spanish were less likely to report age-appropriate cancer examinations, health insurance and a regular health care provider than those who selected to be interviewed in English. Disparities in cancer screenings among vulnerable Hispanic populations could be reduced by promoting the establishment of a regular health care provider.

The Deep South Network for cancer control

Given the recent advances in cancer treatment, cancer disparity between whites and African-Americans continues as an unacceptable health problem. African-Americans face a considerable disparity with regard to cancer incidence, survival, and mortality when compared with the majority white population. On the basis of prior research findings, the Deep South Network (DSN) chose to address cancer disparities by using the Community Health Advisor (CHA) model, the Empowerment Theory developed by Paulo Freire, and the Community Development Theory to build a community and coalition infrastructure. The CHA model and empowerment theory were used to develop a motivated volunteer, grassroots community infrastructure of Community Health Advisors as Research Partners (CHARPs), while the coalition-building model was used to build partnerships within communities and at a statewide level. With 883 volunteers trained as CHARPs spreading cancer awareness messages, both African-Americans and whites showed an increase in breast and cervical cancer screening utilization in Mississippi and Alabama. In Mississippi, taking into account the increase for the state as a whole, the proportion that might be attributable to the CHARP intervention was 23% of the increase in pap smears and 117% of the increase in mammograms. The DSN has been effective in raising cancer awareness, improving both education and outreach to its target populations, and increasing the use of cancer screening services. The National Cancer Institute has funded the Network for an additional 5 years. The goal of eliminating cancer health disparities will be pursued in the targeted rural and urban counties in Mississippi and Alabama using Community-Based Participatory Research. Cancer 2006. (c) 2006 American Cancer Society.

Special populations networks: Themes and lessons learned

The Special Populations Networks (SPN) Program was a 5-year, nationwide project funded by the National Cancer Institute to reduce cancer-related health disparities in minority and other underserved communities by building community health infrastructure, improving cancer awareness and use of cancer screening services, and increasing the cadre of minority junior scientists studying disparities issues. Through collaborations with a wide range of community and academic partners, the 18 grantee organizations: 1) developed culturally sensitive cancer communications approaches and materials; 2) conducted outreach and educational activities appropriate to their communities' needs and diverse cultures; and 3) trained and mentored young minority investigators who succeeded in winning support for pilot projects addressing local cancer health disparities issues, trained and deployed lay health workers, and worked with community and health provider organizations to improve understanding of cancer risk in these populations and encourage participation in appropriate clinical trials. SPN activities were grounded in community-based participatory research principles and practice. This overview highlights major project themes, provides examples of differing individual grantee approaches to similar issues, and describes key lessons learned, as reported by the SPN projects, that may guide future programmatic and research efforts to eliminate cancer health disparities in the United States. Cancer 2006. Published 2006 by the American Cancer Society.

Cancer screening in homeless women: attitudes and behaviors.

Little is known about the use of cancer-screening services in homeless women and their attitudes about early detection programs. Face-to-face interviews were conducted with homeless women in San Francisco to determine rates of clinical breast exams, mammograms, and Pap smears. A total of 105 women were randomly selected from two homeless shelters. By self-report, 51 percent were current on clinical breast exams, 47 percent on mammograms, and 54 percent on Pap smears. These women had very positive attitudes toward receiving cancer-screening exams. In multivariate analyses, discussion about cancer prevention with a health care provider predicted current clinical breast exams and mammograms. More medical visits predicted being current on mammograms and Pap smears. Although homeless women represent a unique group of the urban poor, they are accessing cancer-screening exams at rates comparable to the general population.

Oncology services for members of a national managed care company.

Oncology services in a managed care organization may be defined by the structure of the provider network, coverage policies, and specific health plan programs for oncology services. The policies and programs of Aetna U.S. Healthcare were reviewed to illustrate the approach of a large, national health benefits company in the provision of oncology services to its members. Standard oncology services are provided by a network of independent participating providers, paid fee-for-service. There are no capitated arrangements for oncology services. The process is driven by the participating providers. For patients requiring bone marrow transplant or therapy available in few medical centers, precertification and case management are provided by the health plan, through the National Medical Excellence Unit. Criteria are used to select facilities for these services and global case rates are negotiated. In the health maintenance organization, educational material is distributed by the health plan to physicians and members to encourage the use of cancer screening services. In addition, reimbursement to primary care physicians can be enhanced by the screening rate for their members. The overall policy of Aetna U.S. Healthcare is to cover Phase II and III clinical trials. Coverage for Phase I trials or use of non-Food and Drug Administration approved drugs is based on reported safety and efficacy and participation in an academic program. Through arrangements with participating providers, dedicated support for transplant and rare cases, programs encouraging the use of cancer screening, and member-focused policies on coverage issues, managed care companies can provide complete oncology services to its membership.