Cervical Cancer Screening Among Adult Women in China, 2010

Introduction.

Cervical cancer is one of the most commonly diagnosed cancers among women in China. The World Health Organization (WHO) recommends routine screening for cervical cancer, and the WHO Global Monitoring Framework suggests that every nation monitors cervical cancer screening. However, little information is available on cervical cancer screening behavior among women in China.

Methods.

We used data from the 2010 China Chronic Disease and Risk Factor Surveillance System that included 51,989 women aged 18 years and older. We report the proportion of women who reported ever having had a Papanicolaou (Pap) test, stratified by sociodemographic characteristics and geographic region. Multivariable logistic regression modeling was performed to adjust for potential confounders.

Results.

Overall, 21% of 51,989 women reported having ever had a Pap test. The highest proportion was reported among women aged 30–39 years (30.1%, 95% confidence interval, 26.8%–33.4%). In all geographic regions, women in rural areas were consistently less likely than women in urban areas to report having had a Pap test. Among women who reported ever having a Pap test, 82% reported having the most recent test in the past 3 years. Factors associated with reporting ever having a test were being aged 30–49 years, higher education, being married, and having urban health insurance.

Conclusion.

Our results indicate that screening programs need to be strengthened along with a more intense focus on specific demographic groups. National cervical cancer screening guidelines and comprehensive implementation strategies are needed to make screening services available and accessible to all women.

Implications for Practice:

This study is the largest nationwide and population-based assessment of self-reported history of Pap test for cervical cancer screening in China. This article describes cervical cancer screening behavior among women and examines key demographic and geographic factors. Only one fifth of Chinese women reported having ever had a Pap test for cervical cancer screening. The results highlight the urgent need to develop national cervical cancer screening guidelines and strategies that make screening services widely available, accessible, and acceptable to all women, especially to those who reside in rural areas and those with no health insurance.     

To what extent is women’s economic situation associated with cancer screening uptake when nationwide screening exists? A study of breast and cervical cancer screening in France in 2010

Purpose

In France, larger social inequalities are reported for cervical cancer screening, based on individual practice, than for breast cancer screening for which organized screening exists. Our aim was to investigate the association between women’s economic situation and breast and cervical cancer screening.

Methods

We used data from a large French national health survey conducted in 2010. The economic situation was assessed using the number of adverse economic conditions respondents were facing, based on three variables (low income, lacking food, and perceived financial difficulties). Logistic regressions were adjusted for socioeconomic and sociodemographic characteristics, healthcare use and insurance, and health behaviors.

Results

Mammography was less frequent among women experiencing two or more adverse economic conditions, whereas Pap smear was less frequent among women experiencing at least one adverse economic condition. For both screenings, higher rates were observed among women who lived in the Paris region. Sociodemographic indicators and health behaviors were associated with Pap smear, whereas healthcare use and insurance characteristics were associated with mammography.

Conclusions

The women’s economic situation is an important determinant of breast and cervical cancer screening in France in 2010. Alleviating economic barriers to female cancers screening should be a priority in future programs implementation.     

Does a standard measure of self‐reported physical disability correlate with clinician perception of impairment related to cancer screening?

BACKGROUND:

Adults with physical disabilities are less likely than others to receive cancer screening. It is not known, however, whether commonly used measures assess elements of physical ability necessary for successful screening. The objective of this exploratory study was to determine whether patients who reported limitations in activities of daily living (ADLs) or instrumental ADLs (IADLs) are perceived by their primary care clinicians to have physical limitations that may impede cancer screening.

METHODS:

Patients at 2 rural primary care clinics were surveyed about ADLs and IADLs and about their up‐to‐date status for breast, cervical, and/or colorectal cancer screening. Clinicians and office staff were asked whether they believed each patient had a physical limitation that might impede screening. The agreement between patient and clinician assessments was evaluated.

RESULTS:

Clinicians believed that 43% of patients with severe disability (ADLs) and 30% of patients with moderate disability (IADLs) had limitations that might affect screening. Agreement between patient and clinician assessments was low according to the kappa statistic (κ = 0.355), but had a high percentage of negative agreement (92.3%) and a low percentage of positive agreement (42.7%). Patients with ADL/IADL‐related disability were less likely than nondisabled patients to be current for cervical and breast cancer screening. Patients who were viewed by clinicians as having limitations relevant for screening were less likely to be current for cervical cancer screening.

CONCLUSIONS:

These results indicate that a common measure of general disability may not capture all factors relevant for cancer screening. An instrument designed to include these factors may help identify and accommodate patients who have disabilities that may impede screening. Cancer 2012;. © 2011 American Cancer Society.     

Policy implications of early onset breast cancer among Mexican-origin women

BACKGROUND:

Overall, Latinas are more likely to be diagnosed with a more advanced stage of breast cancer and are 20% more likely to die of breast cancer than non‐Hispanic white women. It is estimated that from 2003 to 2006, $82.0 billion in direct medical care expenditures, in addition to 100,000 lives annually, could be saved by eliminating health disparities experienced by Latinos and increasing the use of up to 5 preventive services in the United States. An additional 3700 lives could be saved if 90% of women aged ≥40 years were recently screened for breast cancer.

METHODS:

The authors examined the risk for breast cancer in a case‐control, population‐based sample of Mexican‐origin women in Harris County, Texas (n = 714), where the rates of breast cancer mortality for Latina women have doubled since 1990.

RESULTS:

Half of breast cancer cases (n = 119) were diagnosed in women aged <50 years. In a multivariate model, women who had a family history of breast cancer (odds ratio [OR], 4.3), who were born in Mexico and had high levels of language acculturation (OR, 2.5), and who did not have health insurance (OR, 1.6) had the highest risk for breast cancer.

CONCLUSIONS:

Because the current results indicated that Mexican‐origin women are at high‐risk for early onset, premenopausal breast cancer, the authors recommended policies that target screening, education, and treatment to prevent increased disparities in mortality. The authors concluded that the inclusion of community members and policymakers as partners in these endeavors would further safeguard against an increase in cancer health disparities and aid in formulating a policy agenda congruent with scientifically based, community‐driven policy efforts that address breast cancer screening, education, and treatment in this vulnerable population. Cancer 2011. © 2010 American Cancer Society.     

A population‐based study of follow‐up care for Hodgkin lymphoma survivors

BACKGROUND:

The majority of Hodgkin lymphoma (HL) patients are cured, and post‐treatment visits are a major component of their management. Little is known about the quality of follow‐up care received by these survivors.

METHODS:

All patients who were diagnosed with HL in Ontario from 1992 through 2000 were identified from a population‐based cancer registry. Individual‐level linkage with physician claims was used to examine the follow‐up care received by 2071 1‐year survivors for up to 15 years after their HL diagnosis. Physician visits, imaging studies, and the use of routine and HL‐specific cancer screening tests were evaluated.

RESULTS:

Most patients had visits with both a primary care provider and an oncologist in Years 2 through 5 after their HL diagnosis. In Year 5 after HL diagnosis, 31.8% of patients had at least 1 computed tomography (CT) scan, and 62.9% had a chest x‐ray. There were 5352 CT scans performed in Years 2 through 5, and 125 patients subsequently received chemotherapy within 6 months of a CT. Among the survivors who met age criteria for routine screening, 62.5% had no evidence of colorectal cancer screening during Years 2 through 15, 32.3% had no evidence of breast cancer screening, and 19.9% had no evidence of cervical cancer screening. Among young women potentially at high risk of breast cancer because of radiation therapy, 87.1% had not received the recommended breast cancer screening.

CONCLUSIONS:

Radiologic surveillance of HL survivors rarely led to salvage therapy. Despite frequent physician contact, many survivors did not receive established cancer screening interventions, and the recommended early initiation of breast cancer screening among young women at high risk was not widely used. Cancer 2010. © 2010 American Cancer Society.     

Data and trends in cancer screening in the United States

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. Cancer 2010. Published 2010 by the American Cancer Society.     

Breast and cervical cancer screening behaviours among colorectal cancer survivors in Nova Scotia

Purpose

We analyzed patterns and factors associated with receipt of breast and cervical cancer screening in a cohort of colorectal cancer survivors.

Methods

Individuals diagnosed with colorectal cancer in Nova Scotia between January 2001 and December 2005 were eligible for inclusion. Receipt of breast and cervical cancer screening was determined using administrative data. General-population age restrictions were used in the analysis (breast: 40–69 years; cervical: 21–75 years). Kaplan–Meier and Cox proportional hazards models were used to assess time to first screen.

Results

Of 318 and 443 colorectal cancer survivors eligible for the breast and cervical cancer screening analysis respectively, 30.1% [95% confidence interval (ci): 21.2% to 39.0%] never received screening mammography, and 47.9% (95% ci: 37.8% to 58.0%) never received cervical cancer screening during the study period. Receipt of screening before the colorectal cancer diagnosis was strongly associated with receipt of screening after diagnosis (hazard ratio for breast cancer screening: 4.71; 95% ci: 3.42 to 6.51; hazard ratio for cervical cancer screening: 6.83; 95% ci: 4.58 to 10.16).

Conclusions

Many colorectal cancer survivors within general-population screening age recommendations did not receive breast and cervical cancer screening. Future research should focus on survivors who meet age recommendations for population-based cancer screening.     

Predictors of Breast and Cervical Cancer Screening among Chamorro Women in Southern California

This study examined the role of sociodemographic characteristics, health insurance, cancer knowledge, perceived health risk, and having a recent physicians’ visit on breast and cervical cancer screening utilization among a randomly selected group of Chamorro women (n = 250) residing in San Diego, California. Data were collected by a telephone survey and analyzed using multiple logistic regression models. After adjusting for covariates, having a recent full exam was the strongest predictor of having had a Pap exam in the past 2 years for women 21 years and older and a clinical breast exam in the past 2 years for women 40 years and over.     

Minimal social network effects evident in cancer screening behavior

BACKGROUND:

Social networks may influence screening behaviors. We assessed whether screening for breast, prostate, or colorectal cancer is influenced by the actual screening behaviors of siblings, friends, spouses, and coworkers.

METHODS:

We conducted an observational study using Framingham Heart Study data to assess screening for eligible individuals during the late 1990s. We used logistic regression to determine whether the probability of screening for breast, prostate, or colorectal cancer was influenced by the proportion of siblings, friends, and coworkers who had the same screening, as well as spouse's screening for colorectal cancer, adjusting for other factors that might influence screening rates.

RESULTS:

Among 1660 women aged 41‐70 years, 71.7% reported mammography in the previous year; among 1217 men aged 51‐70 years, 43.3% reported prostate‐specific antigen testing in the previous year; and among 1426 men and women aged 51‐80 years, 46.9% reported stool blood testing and/or sigmoidoscopy in the previous year. An increasing proportion of sisters who had mammography in the previous year was associated with mammography screening in the ego (odds ratio [OR], 1.034; 95% confidence interval [CI], 1.000‐1.065 for each 10% increase). A spouse with recent screening was associated with more colorectal cancer screening (OR, 1.65; 95% CI, 1.39‐1.98 vs unmarried). Otherwise, screening behaviors of siblings, friends, and coworkers were not associated with screening in the ego.

CONCLUSIONS:

Aside from a slight increase in breast cancer screening among women whose sisters were screened and colorectal cancer screening if spouses were screened, the screening behavior of siblings, friends, or coworkers did not influence cancer screening behaviors. Cancer 2011. © 2011 American Cancer Society.     

Determinants of cancer screening in Asian-Americans

Purpose

Recent data suggest that Asian-Americans (AsAs) are more likely to present with advanced disease when diagnosed with cancer. We sought to determine whether AsAs are under-utilizing recommended cancer screening.

Methods

Cross-sectional analysis of the 2012 Behavioral Risk Factor Surveillance System comprising of AsAs and non-Hispanic White (NHW) community-dwelling individuals (English and Spanish speaking) eligible for colorectal, breast, cervical, or prostate cancer screening according to the United States Preventive Services Task Force recommendations. Age, education and income level, residence location, marital status, health insurance, regular access to healthcare provider, and screening were extracted. Complex samples logistic regression models quantified the effect of race on odds of undergoing appropriate screening. Data were analyzed in 2015.

Results

Weighted samples of 63.3, 33.3, 47.9, and 30.3 million individuals eligible for colorectal, breast, cervical, and prostate cancer screening identified, respectively. In general, AsAs were more educated, more often married, had higher levels of income, and lived in urban/suburban residencies as compared to NHWs (all p < 0.05). In multivariable analyses, AsAs had lower odds of undergoing colorectal (odds ratio [OR] 0.78, 95 % confidence interval [CI] 0.63–0.96), cervical (OR 0.45, 95 % CI 0.36–0.55), and prostate cancer (OR 0.55, 95 % CI 0.39–0.78) screening and similar odds of undergoing breast cancer (OR 1.29, 95 % CI 0.92–1.82) screening as compared to NHWs.

Conclusions

AsAs are less likely to undergo appropriate screening for colorectal, cervical, and prostate cancer. Contributing reasons include limitations in healthcare access, differing cultural beliefs on cancer screening and treatment, and potential physician biases. Interventions such as increasing healthcare access and literacy may improve screening rates.

     

The impact of a national program to provide free mammograms to low‐income,uninsured women on breast cancer mortality rates

BACKGROUND:

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides free or low‐cost breast and cervical cancer screening to low‐income, uninsured or underinsured women. The authors analyzed the impact of the NBCCEDP on breast cancer mortality rates.

METHODS:

The data consisted of observations for each state and year for the period from 1990 through 2004. The outcome variable was the breast cancer mortality rate for women ages 40 to 64 years. Independent variables included the proportion of women ages 40 to 64 years screened under NBCCEDP. The impact of screening intensity was estimated using least‐squares regression with state and year fixed effects.

RESULTS:

In 2004, 1.2% of women ages 40 to 64 years were screened under NBCCEDP. The NBCCEDP screening rate was related significantly and negatively to breast cancer mortality in the same year. Results indicate that, for every 1000 women screened, there were 0.6 fewer deaths because of breast cancer among women ages 40 to 64 years. Changes in screening rates were unrelated to breast cancer mortality ≥2 years in the future.

CONCLUSIONS:

In the current study, there was some evidence suggesting that the NBCCEDP led to a reduction in breast cancer mortality rates. However, the failure to detect an impact of screening on mortality rates in subsequent years suggests that caution is needed in interpreting these results as strong evidence in favor of the effectiveness of the NBCCEDP in reducing breast cancer mortality. Cancer 2010. © 2010 American Cancer Society.     

Alcohol consumption and rates of cancer screening: Is cancer risk overestimated?

Purpose

Alcohol consumption in moderation has been associated with incident breast and colorectal cancer. Whether these associations may be overestimated by more intensive screening among moderate consumers is unknown. This study examines the associations of alcohol consumption with cancer screening.

Methods

In six iterations (2002–2012) of the Behavioral Risk Factor Surveillance System, a telephone survey of US adults conducted by the Centers for Disease Control and Prevention, participants reported their alcohol use and recent screening for several cancers. We assessed whether alcohol use was associated with breast, cervical, and colorectal cancer screening after sample-weighted adjustment for sociodemographic and healthcare utilization factors.

Results

Among 2,191,483 survey respondents, 80.5 % (weighted prevalence) of eligible individuals reported having an up-to-date mammogram, 87.7 % having a Pap test, and 56.8 % having a colonoscopy/sigmoidoscopy. For all breast, cervical, and colorectal cancers, moderate consumers were more likely to report screening (84.7, 91.2, 61.1 %) than non-consumers, even after multivariate adjustment (adjusted prevalence ratios 1.04, 1.04, 1.07; p < 0.001 for all). Among binge consumers, the weighted prevalence was lower than that in non-binge consumers (binge vs non-binge moderate consumers 80.5 vs 85.5 %, 89.9 vs 91.8 %, 52.8 vs 63.3 %) but still higher than non-consumers for breast and cervical cancer screening.

Conclusions

In the USA, moderate consumers consistently report a greater likelihood of breast, cervical, and colorectal cancer screening than do non-consumers. Given the likelihood of overdiagnosis, further study of alcohol consumption and cancer should include cancer-specific mortality, which is less sensitive to differences in screening and detection.

     

Experiences and perceptions regarding clinical breast exam screening by trained laywomen in Malawi

Purpose

Despite the increasing burden, breast cancer control in sub-Saharan Africa is insufficient. Late diagnosis and lack of early detection and screening services contribute to high mortality. Clinical breast exam (CBE) screening can be valuable in low-income countries, including use of community health workers and non-health professionals to conduct exams. We assessed experiences of women who underwent CBE screening by trained laywomen in Lilongwe, Malawi, as part of a pilot program.

Methods

The pilot study invited women attending urban health clinics to a breast cancer educational talk followed by CBE screening by trained laywomen. We purposively sampled participants from the pilot study and interviewed them about the screening experience and future cancer education programs and services.

Results

Overall participants had positive experiences and were willing to undergo CBE screening by trained laywomen. Participants were motivated by the educational talk, shared newly acquired cancer knowledge with their social networks, and encouraged others to seek screening. Screened women suggested strategies for future interventions including combining breast and cervical cancer screening, using female providers, partnering with community leaders to increase uptake, and expanding services into the community.

Conclusions

Asymptomatic Malawian women accepted CBE screening by trained laywomen and considered breast cancer an important health issue. Women appreciated combined education and screening services and proposed further linkage of breast and cervical cancer screening. Based on our results, training laywomen to educate the public on breast cancer and conduct CBE is a feasible breast cancer control strategy in sub-Saharan Africa.

     

Racial variation in tumor stage at diagnosis among Department of Defense beneficiaries

BACKGROUND:

Tumor stage at diagnosis often varies by racial/ethnic group, possibly because of inequitable health care access. Within the Department of Defense (DoD) Military Health System, beneficiaries have equal health care access. The objective of this study was to determine whether tumor stage differed between whites and blacks with breast, cervical, colorectal, and prostate cancers, which have effective screening regimens, based on data from the DoD Automated Cancer Tumor Registry from 1990 to 2003.

METHODS:

Distributions of tumor stage (localized vs nonlocalized) between whites and blacks in the military were compared stratified by sex, active duty status, and age at diagnosis. Logistic regression was used to further adjust for age, marital status, year of diagnosis, geographic region, military service branch, and tumor grade. Distributions of tumor stage were then compared between the military and general populations.

RESULTS:

Racial differences in the distribution of stage were significant only among nonactive duty beneficiaries. After adjusting for covariates, earlier stages of breast cancer after age 49 years and prostate cancer after age 64 years were significantly more common among white than black nonactive duty beneficiaries (P < .05), although the absolute difference was minimal for prostate cancer. Racial differences in stage for cervical and colorectal cancers were not significant after adjustment. Compared with the general population, racial differences in the military were similar or were slightly attenuated.

CONCLUSIONS:

Racial disparities in stage at diagnosis were apparent in the DoD equal‐access health care system among older nonactive duty beneficiaries. Socioeconomic status, supplemental insurance, cultural beliefs, and biologic factors may be related to these results. Cancer 2012;. © 2011 American Cancer Society.     

The Breast and Cervical Cancer Prevention and Treatment Act in Georgia

BACKGROUND:

Implementation of the Breast and Cervical Cancer Prevention and Treatment Act of 2000 (BCCPTA) allowed states to extend Medicaid to any woman aged <65 without insurance screened and found to need treatment either for breast or cervical cancer or for a precancerous cervical condition through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) or in Georgia, other provider sites.

METHODS:

The authors used linked Georgia Comprehensive Cancer Registry (GCCR) and Medicaid data to test the: 1) likelihood of Medicaid enrollment in a given month and 2) time‐to‐enrollment (months) for those eventually enrolling. The authors used difference‐in‐differences analysis to estimate the effects of BCCPTA for breast or cervical cancer cases relative to a control group of women with other cancers. The authors controlled for sociodemographics, stage at diagnosis, year of diagnosis, and county level factors related to insurance levels in the area.

RESULTS:

Compared with the control cancer group, the hazard ratio of Medicaid enrollment for women with breast and cervical cancers increased post‐ vs pre‐BCCPTA implementation. The estimated effect of this increase was that out of every 1000 women with breast cancer, BCCPTA led to 1.7 more (from 2.8 to 4.5 per month) enrolling in Medicaid. The results for women with local or later stages of cervical cancer indicated that of 1000 women with these cancers, the number enrolling in a given month increased by 3.4 due to BCCPTA. Results on time‐to‐enrollment indicated that the time between cancer diagnosis and enrollment was shortened by 7 to 8 months.

CONCLUSIONS:

The Georgia Medicaid program, in response to national legislation, increased the probability of women enrolling in Medicaid earlier and in turn, likely increased their cancer treatment options. Cancer 2009. © 2009 American Cancer Society.     

Underuse of colorectal cancer screening among men screened for prostate cancer

BACKGROUND:

Evidence suggests that colorectal cancer (CRC) screening reduces disease‐specific mortality, whereas the utility of prostate cancer screening remains uncertain. However, adherence rates for prostate cancer screening and CRC screening are very similar, with population‐based studies showing that approximately 50% of eligible US men are adherent to both tests. Among men scheduled to participate in a free prostate cancer screening program, the authors assessed the rates and correlates of CRC screening to determine the utility of this setting for addressing CRC screening nonadherence.

METHODS:

Participants (N = 331) were 50 to 70 years old with no history of prostate cancer or CRC. Men registered for free prostate cancer screening and completed a telephone interview 1 to 2 weeks before undergoing prostate cancer screening.

RESULTS:

One half of the participants who underwent free prostate cancer screening were eligible for but nonadherent to CRC screening. Importantly, 76% of the men who were nonadherent to CRC screening had a regular physician and/or health insurance, suggesting that CRC screening adherence was feasible in this group. Furthermore, multivariate analyses indicated that the only significant correlates of CRC screening adherence were having a regular physician, health insurance, and a history of prostate cancer screening.

CONCLUSIONS:

Free prostate cancer screening programs may provide a teachable moment to increase CRC screening among men who may not have the usual systemic barriers to CRC screening, at a time when they may be very receptive to cancer screening messages. In the United States, a large number of men participate in annual free prostate cancer screening programs and represent an easily accessible and untapped group that can benefit from interventions to increase CRC screening rates. Cancer 2010. © 2010 American Cancer Society.     

Impact of insurance type on survivor-focused and general preventive health care utilization in adult survivors of childhood cancer: the Childhood Cancer Survivor Study (CCSS)

BACKGROUND:

Lack of health insurance is a key barrier to accessing care for chronic conditions and cancer screening. The influence of insurance type (private, public, none) on survivor‐focused and general preventive health care in adult survivors of childhood cancer was examined.

METHODS:

The Childhood Cancer Survivor Study is a retrospective cohort study of childhood cancer survivors diagnosed between 1970 and 1986. Among 8425 adult survivors, the relative risk (RR) and 95% confidence interval (CI) of receiving survivor‐focused and general preventive health care were estimated for uninsured (n = 1390) and publicly insured (n = 640), compared with for the privately insured (n = 6395)

RESULTS:

Uninsured survivors were less likely than those privately insured to report a cancer‐related visit (adjusted RR, 0.83; 95% CI, 0.75‐0.91) or a cancer center visit (adjusted RR, 0.83; 95% CI, 0.71‐0.98). Uninsured survivors had lower levels of utilization in all measures of care in comparison with privately insured. In contrast, publicly insured survivors were more likely to report a cancer‐related visit (adjusted RR, 1.22; 95% CI, 1.11‐1.35) or a cancer center visit (adjusted RR, 1.41; 95% CI, 1.18‐1.70) than were privately insured survivors. Although publicly insured survivors had similar utilization of general health examinations, they were less likely to report a Papanicolaou test or a dental examinations

CONCLUSIONS:

Among this large, socioeconomically diverse cohort, publicly insured survivors utilize survivor‐focused health care at rates at least as high as survivors with private insurance. Uninsured survivors have lower utilization of both survivor‐focused and general preventive health care. Cancer 2011. © 2010 American Cancer Society.     

Fluctuating Behavior of the French Population in Cancer Screening: 5th Edition of the EDIFICE Survey

Background

The EDIFICE surveys have assessed cancer screening behavior in the French population since 2005.

Methods

The 2016 edition was conducted among a representative sample of 1501 individuals (age, 50–75 years). The current analysis focuses on breast, colorectal, prostate, lung, and cervical cancer screening.

Results

The rate of women (50 to 74 years) declaring having had at least one breast cancer screening test in their lifetime remained stable and high between 2005 and 2016. Compliance with recommended screening intervals improved between 2005 and 2011 from 75 to 83%, respectively, then decreased significantly to 75% in 2016 (P?=?0.02). Uptake of at least one lifetime colorectal cancer screening test procedure declared (individuals aged 50–74 years) increase from 25% in 2005 to 59% in 2011, stabilized at 60% in 2014, then reached 64% in 2016. Opportunistic prostate cancer screening (men aged 50–75 years) rose between 2005 and 2008 from 36 to 49%, plateaued until 2014 then dropped to 42% in 2016. The proportion of women aged 50–65 declaring having undergone one cervical cancer screening test dropped significantly between 2014 and 2016 from 99 to 94% (P?<?0.01). Lastly, 11% of our survey population in 2014 and 2016 (55–74 years) declared having already undergone lung cancer screening.

Conclusion

Cancer screening behavior fluctuates in France, regardless of the context, i.e., organized programs or opportunistic screening. This observation highlights the need for constant analysis of population attitudes to optimize public awareness campaigns.

     

Effectiveness of population-based service screening with mammography for women ages 40 to 49 years: evaluation of the Swedish Mammography Screening in Young Women (SCRY) cohort

BACKGROUND:

The effectiveness of mammography screening for women ages 40 to 49 years still is questioned, and few studies of the effectiveness of service screening for this age group have been conducted.

METHODS:

Breast cancer mortality was compared between women who were invited to service screening at ages 40 to 49 years (study group) and women in the same age group who were not invited during 1986 to 2005 (control group). Together, these women comprise the Mammography Screening of Young Women (SCRY) cohort, which includes all Swedish counties. A prescreening period was defined to facilitate a comparison of mortality in the absence of screening. The outcome measure was refined mortality, ie, breast cancer death for women who were diagnosed during follow‐up at ages 40 to 49 years. Relative risks (RRs) with 95% confidence intervals (CIs) were estimated.

RESULTS:

There was no significant difference in breast cancer mortality during the prescreening period. During the study period, there were 803 breast cancer deaths in the study group (7.3 million person‐years) and 1238 breast cancer deaths in the control group (8.8 million person‐years). The average follow‐up was 16 years. The estimated RR for women who were invited to screening was 0.74 (95% CI, 0.66‐0.83), and the RR for women who attended screening was 0.71 (95% CI, 0.62‐0.80).

CONCLUSIONS:

In this comprehensive study, mammography screening for women ages 40 to 49 years was efficient for reducing breast cancer mortality. Cancer 2011. © 2010 American Cancer Society.