By Lori Solomon, Editor, Diagnostic Testing & Emerging Technologies
Many adults are not getting recommended, routine screenings for cervical and colorectal cancer, according to the U.S. Centers for Disease Control and Prevention (CDC). Screening rates for colorectal cancer remain unchanged since 2010, while rates of cervical cancer screening have actually fallen.
Researchers analyzed data from the National Health Interview Survey 2013, the most recent year for which data was available. Data from this annual survey of a nationally representative sample of the U.S. civilian population is used to monitor progress toward Healthy People 2020 cancer-screening goals based on U.S. Preventive Services Task Force guidelines.
The findings, published May 8 in Morbidity and Mortality Weekly Report, show that all cancer-screening rates fall below stated Healthy People 2020 goals. Recommendations call for Papanicolaou (Pap) test within 3 years for women without hysterectomy aged 21 to 65 years. Yet, CDC found that one in five women report not being up-to-date with cervical cancer screening. In 2013, 80.7 percent of women reported having a Pap test, which is below the Healthy People 2020 target of 93.0 percent and a significant 5.5 percent decline since 2000.
"In 2012, screening every 5 years with a combination of Pap and human papillomavirus tests also was included as a screening option for some women aged 30 [to] 65 years," explain the authors led by Susan Sabatino, M.D., from CDC’s division of Cancer Prevention and Control. "It is unknown whether screening intervals might have been lengthened for some women after the 2012 updated recommendation, and if so, whether this might have contributed to decreased screening use as measured in the 2013 findings."
Screening rates for colorectal cancer remained unchanged. In 2013, roughly two in five adults reported not being up-to-date with colorectal cancer screening. Recommendations call for screening with either fecal occult blood test (FOBT), sigmoidoscopy and FOBT, or colonoscopy among adults aged 50 to 75 years. In 2013, 58.2 percent of adults in this age range report being screened for colorectal cancer. Screening rates were lower among younger respondents (aged 50 to 64 years) versus those 65 to 75 years of age (52.8 percent versus 69.4 percent). While overall colorectal screening use increased significantly by 24.6 percentage points from 2000 to 2013, 2013 rates were still below the Healthy People 2020 target of 70.5 percent. Colonoscopy is more commonly used than other screening options, but the CDC is optimistic that further promotion of "all recommended CRC testing options, including less invasive methods" will increase test use.
The data also revealed screening disparities. While screening rates were similar between whites and blacks (but lower for Hispanics), the study found that adults without insurance or a usual source of health care generally had the lowest screening test use. Less than one-fourth of adults in these low-access groups reported recent colorectal cancer screening, compared with more than 60 percent of adults with private insurance or a usual source of health care. The proportion of people obtaining screening increased with higher education and income.
"Those furthest below targets were generally those without insurance or a usual source of care," writes Sabatino. "For these groups, screening use was 42 [to] 53 percentage points below breast and CRC screening targets, and approximately 30 percentage points below the cervical cancer screening target."