U.S. cancer screening rates in 2010 were below national targets for 2020, particularly among Asians and Hispanics, according to a report issued Jan. 26 by the Centers for Disease Control and Prevention and the National Cancer Institute.
"It is troubling to see that not all Americans are getting the recommended cancer screenings, and that disparities continue to persist for certain populations," Dr. Sallyann Coleman King, the study’s lead author and an epidemic intelligence service officer in the CDC’s Division of Cancer Prevention and Control, said in a statement.
National Institutes of Health/Department of Health and Human Services
A report on U.S. cancer screening rates in 2010 noted that the overall rate of breast cancer screening was 72.4%, well under the 81.1% target of screening via mammogram (pictured above) for 2020.
The study’s authors used data from the 2010 National Health Interview Survey, which is monitoring progress toward the screening goals in Healthy People 2020 (MMWR Morb. Mortal. Wkly. Rep. 2012;61:41-5). That initiative has set objectives for improving the health of Americans – including the use of screening tests for breast, cervical, and colorectal cancer, as recommended by the U.S. Preventive Services Task Force.
This is the first federal study that has identified disparities in cancer screening rates among Asian and Hispanic groups, according to the CDC.
The results illustrate "the particular need for finding ways to increase the use of breast, cervical, and colorectal cancer screening tests among Asians, Hispanics, as well as adults who lack health insurance or a usual source of health care," noted study coauthor Carrie Klabunde, Ph.D., an epidemiologist in the NCI’s Division of Cancer Control and Population Sciences.
The Health People 2020 screening goals for breast, cervical, and colorectal cancer are:
– 81.1% of women aged 50-74 years undergo breast cancer screening via mammography every 2 years.
– 93% of women aged 21-65 years with a cervix undergo Pap smear testing every 3 years to screen for cervical cancer and precancerous lesions.
– 70.5% of both men and women are screened regularly for colorectal cancer between the ages of 50 years and 75 years.
In the new study, Dr. King and her associates found that:
– The overall rate of breast cancer screening was 72.4%. Between 2000 and 2010, screening rates for breast cancer were "relatively stable," according to the CDC, with no more than a 3% variation during that time.
– The overall rate of cervical cancer screening was 83%. However, during the decade, the rate of women who said they had had a Pap test within the previous 3 years dropped by 3.3% – a small but statistically significant reduction.
– The overall rate of colorectal cancer screening among men and women was 58.6%. During the 2000-2010 period, colorectal cancer screening rates "increased markedly" for both sexes, and were almost identical for men (58.5%) and women (58.8%). The rate for women had increased slightly faster during the decade, to catch up with the rate for men.
Among Asians (Chinese, Filipino, or other Asians), screening rates for all three cancers were significantly lower: 64.1% for breast cancer, 75.4% for cervical cancer, and 46.9% for colorectal cancer. Among Hispanics (Puerto Rican, Mexican, Mexican-American, Central or South American, or other Hispanics), the screening rates were lower for cervical (78.7%) and for colorectal cancer (46.5%), compared with non-Hispanics (83.8% and 59.9%, respectively).
Not having a usual source of health care or health insurance was associated with "considerably" lower rates for screening of all three cancers.
Among women with no usual source of health care or no health insurance, mammography rates were much lower, at about 36%-38%. And although immigrant women who had lived in the United States for a decade were nearly as likely as were women born in the United States to have had a mammogram (about two-thirds), 46.6% of women who had lived in the United States for less than 10 years said they had been screened in the previous 2 years.
While financial barriers to screening "might explain some of the disparities in cancer screening rates," the report referred to national programs that provide free or low-cost breast, cervical, and colorectal screening. The study’s authors also noted that the Affordable Health Care Act is expected to help people who can’t afford screening by expanding insurance coverage.
"Efforts should be made to improve screening rates in all population groups," including targeted efforts for groups with particularly low screening rates, the report authors said. In addition, "other efforts are needed, such as developing systems that identify persons eligible for cancer screening tests, actively encouraging the use of screening tests, and monitoring participation to improve screening rates."