Cancer Screening Rates in the US Fall Short of Healthy People 2020 Targets

With Healthy People 2020 goals of achieving health equity, eliminating disparities, and improving the health of all groups, cancer screening plays an integral role in achieving these goals. However, cancer screening rates in the United States fall short of these targets and significant disparities exist among subgroups, according to CDC data.

The agency’s research focused on breast, cervical, colorectal, and prostate cancers, as these accounted for nearly 40% of new cancer diagnoses and close to 20% of cancer deaths in 2013. Among the goals of Healthy People 2020 are increasing the proportion of women aged 21 to 65 years screened for cervical cancer, women aged 50 to 74 years screened for breast cancer, and men and women aged 50 to 75 years screened for colorectal cancer. Their goals also include reducing prostate cancer deaths.

Using the National Health Interview Study, researchers collected data from participants on Papanicolau (Pap) tests and hysterectomies, mammograms, prostate-specific antigen (PSA) tests, and endoscopic exams and fecal occult blood tests (FOBTs) screening for colorectal cancer. Women were considered to have been screened recently for breast cancer if they had a mammogram within 2 years and cervical cancer if they had a Pap test within 3 years.

Having an FOBT within the past year, a flexible sigmoidoscopy within 5 years and an FOBT within 3 years, or a colonoscopy within 10 years signified a recent colorectal cancer screening. The authors noted that at the time of analysis, the US Preventive Services Task Force (USPSTF) was following its 2012 guideline that recommended against routine PSA screening.

Of the 83% of women who received a recent Pap test, women aged 21 to 30 and women aged 51 to 60 years were less likely to have been screened. More than two-thirds (71.7%) of women also reported having a recent mammogram. Similar to Pap testing, mammography testing was least likely among those aged 50 to 64 years. Although screening rates were high, they fell short of the Healthy People 2020 targets of 93% for Pap tests and 81% for mammography.

For colorectal screening, 63.4% of women and 61.9% of men reported having a recent screening, falling below the target of 80%.

Across the 3 screening methods, having less than a high school education, having no usual source of care, having public insurance, and being underinsured were associated with lower testing rates.

Among men, 35.8% reported having a recent PSA test in the past year.

Between 2000 and 2015, Pap test use declined by 4.3% among women with a usual source of care and mammography rates declined by 3%. Only use of colorectal cancer screening has increased significantly and consistently, rising 25.1% among women between 2000 and 2010. Rates stayed stable between 2010 and 2013 and then increased slightly in 2015. Colorectal cancer screening among men also increased significantly.

Use of a PSA test declined by 9.2% from 2008 to 2013 but remained stable between 2013 and 2015. The authors noted that this drop can be attributed to USPSTF’s recommendation against routine screening and, subsequently, a drop in the test being offered by physicians and used by patients. Earlier this year, USPSTF updated their recommendation, calling for men aged 55 to 69 years to make their own decision on whether to be screened periodically for prostate cancer after they have had a conversation with their physician on potential benefits and harms.

“One approach to improving screening use across all subgroups would be for physicians to recommend screening to all age-appropriate patients, including traditionally underserved groups,” they wrote. They add that physician enthusiasm and outreach with tailored or innovative strategies to educate and inform may increase knowledge and intention to screen among these underserved groups.

Reference

Hall I, Tangka F, Sabatino S, et al. Patterns and trends in cancer screening in the United States [published online July 26, 2018]. Prev Chronic Dis. doi: 10.5888/pcd15.170465.