The percentages of people in the United States who followed recommended guidelines for cervical and prostate cancer screening dropped between 1999 and 2010, while participation rates for mammography remained essentially unchanged and rates for colorectal cancer screening climbed slightly, according to a study of practices among 174,393 adults.
Well-established cancer screening techniques are cornerstones of effective prevention and care, but cornerstones can slip. The percentage of people in the United States who follow recommended guidelines for cervical and prostate cancer screening dropped between 1999 and 2010, while rates for mammography remained essentially unchanged and rates for colorectal cancer screening climbed slightly, according to a study led by researchers at the University of Miami's Miller School of Medicine in Florida.
Overall, “adherence rates for cancer screenings have generally declined,” says Tainya Clarke, MPH, research associate in the Department of Epidemiology and Public Health. Clarke is lead author of an article published in Frontiers in Cancer Epidemiology and Prevention, which looked at practices in following American Cancer Society screening guidelines by 174,393 adults reported in the National Health Interview Survey.
This slippage is due to many factors, but the researchers speculated that drops in the number of people with full employer-paid health benefits over the decade may be the most important.
“Disparities in health insurance play an important role,” says Clarke. “If you have health insurance, then you can afford preventive care. If you don't, it's something else you have to consider paying for. We see differences in cancer screening between the employed and the unemployed, and differences by occupation among those employed.”
One finding from the study, she notes, is that among working cancer survivors, 71.8% of white-collar workers, 63.6% of blue-collar workers, and 62.3% of service workers reported receiving screening for colorectal cancer in 2010.
As provisions of the Affordable Care Act come into effect, Clarke suggests, they may help to lower these disparities.
Among all the adults surveyed, colorectal cancer screening rates climbed 16.6% over the decade, reaching 54.6% in 2010. That result exceeded the goal of 50% for people over 50 years of age set by the Healthy People 2010 (HP2010) standard. (Each decade, the U.S. Department of Health and Human Services establishes Healthy People goals as baselines for achievable improvements in health practices; the newer Healthy People 2020 standards set the bar higher.)
No other HP2010 cancer screening goals were met. The rate of self-reported Pap smears dropped by 3.7%, reaching a total of 85.5% of women in the total population, compared with the HP2010 goal of 90% for cervical cancer tests. (The guidelines now suggest testing between 21 and 65 years of age, rather than from 18 years of age on, and some physicians believe that human papillomavirus tests may replace Pap smears.)
Mammography rates stayed about the same, at 69.4% of women over 40 years of age, just under the HP2010 goal of 70%.
In prostate cancer, in 2010 46.0% of men over 50 years of age reported getting a prostate-specific antigen (PSA) test within the previous year, compared with 64.6% of that group in 1999. (HP2010 did not set goals for prostate cancer screening, and guidelines now call for men to discuss PSA tests with their physicians rather than necessarily taking the test.)
Unsurprisingly, rates of adherence to screening guidelines were considerably higher among the 12,990 cancer survivors surveyed, although the study revealed small declines in cervical and prostate cancer screening rates among survivors over the decade.
Some of the American Cancer Society guidelines not only changed over the decade but also conflict with U.S. Preventive Services Task Force recommendations. These altered recommendations may have contributed to decreased adherence, the researchers suggested. “The general public doesn't understand the reasoning behind these changing guidelines,” Clarke notes.