Medical Record-Documented TNM Categories and Stage Group: Feasibility of Use for Cancer Surveillance.

BACKGROUND AND OBJECTIVES: In 2016, with the discontinuation of the Collaborative Staging system, the cancer surveillance community planned to rely on physician-assigned TNM stage documented in the medical record. The objectives of this study were to describe how often physician-assigned staging components were documented in the medical records accessible to the registrar and to assess the agreement of these physician-assigned components with registrar-assigned values. METHODS: Medical record documents for 282 routine cases from 5 cancer sites were selected from the Surveillance, Epidemiology, and End Results registries. First, the documents were evaluated to determine how often they contained the TNM staging components. Next, the available components were compared with values assigned by a panel of experienced cancer registrars. The agreement for each type of source document was estimated among 100 cases. RESULTS: Overall, the physician-assigned TNM components and stage groups were not often found in the medical record. Pathologic T and N were found most frequently (65% and 64%, respectively). Agreement between physician-assigned and registrar-assigned TNM components varied (cT = 57%, cN = 72%, pT = 83%, pN = 89%). For stage group, agreement was better when the stage group was documented more than once (clinical, 71%; pathologic, 67%). Path reports included valid pT and pN in 79% and 89% of cases, respectively. Oncology consultation notes provided valid cT for 83% of cases. Validity was lower for other document sources. CONCLUSIONS: The physician-assigned TNM components will rarely be documented in the medical record and available to the registrar. Collection of accurate stage information for cancer surveillance requires cancer registrars to review the full medical record and assign the TNM components required for stage.

Self-reported oral cancer screening by smoking status in Maryland: trends over time.

OBJECTIVES: The study aims to examine whether a higher proportion of current and former smokers reported having an oral cancer screening (OCS) exam in the past year compared with never smokers in Maryland between 2002 and 2008. METHODS: Secondary analysis of the Maryland Cancer Surveys (conducted in 2002, 2004, 2006, and 2008), population-based, random-digit-dial surveys on cancer screening among adults age 40 years and older. Of 20,197 individuals who responded to the surveys, 19,054 answered questions on OCS and smoking. Results are weighted to the Maryland population. RESULTS: Self-reported OCS in the past year increased from 33 percent in 2002 to 40 percent in 2008. Screening among never and former smokers increased from about 35 percent to 42 percent and from 35 percent to 43 percent, respectively; screening among current smokers remained between 23 percent and 25 percent. In the adjusted analysis, current smokers had decreased odds of screening compared with never smokers; no significant difference was observed between former and never smokers. When the variable dental visit in the last year was included in the adjusted analysis, it became the strongest predictor of OCS. CONCLUSIONS: Between 2002 and 2008, self-reported OCS in the last year increased among former and never smokers, but remained unchanged for current smokers. A visit to a dental professional attenuated the difference in OCS between current and never smokers. Dental visit in the last year was the strongest predictor of OCS.

Predictors of repeated PSA testing among black and white men from the Maryland Cancer Survey, 2006.

INTRODUCTION: Blacks have the highest incidence of and death from prostate cancer in the United States. Screening with prostate-specific antigen (PSA) may decrease mortality. Repeated testing allows for the calculation of PSA velocity (change of PSA over time), which may be a more clinically useful test for prostate cancer than a single PSA measurement. The objective of this study was to examine whether blacks were as likely as whites to report having had repeated PSA testing. METHODS: The Maryland Cancer Survey 2006 was a population-based, random-digit-dialed statewide survey on cancer screening and risk behaviors of adults aged 40 years or older. We analyzed self-reported information on repeated PSA testing (2 PSA tests in the preceding 3 years) for 1,721 black and white men. We used logistic regression to estimate the effect of race and age on repeated PSA testing, adjusting for other covariates. RESULTS: Sixty-five percent of men reported ever having had a PSA test; 41% had repeated PSA testing in the past 3 years. Blacks aged 40 to 49 were more likely to report having repeated PSA testing than whites in this age group (adjusted odds ratio [AOR], 3.3; 95% confidence interval [CI], 1.6-6.5). Blacks aged 60 to 69 were less likely to report repeated PSA testing than whites (AOR, 0.4, 95% CI, 0.2-0.8). No difference was seen by race among men aged 50 to 59 and men aged 70 or older. Repeated PSA testing was associated with living in an urban area and with having higher education, health insurance, a family history of prostate cancer, and having discussed cancer screening with a doctor. CONCLUSION: Self-reported repeated PSA testing differed by age and race, being higher among blacks aged 40 to 49 and lower among blacks aged 60 to 69, compared with whites in their respective age groups.

Trends in self-reported health care provider recommendations for colorectal cancer screening by race.

OBJECTIVE: To examine whether a racial difference exists in self-reported recommendations for colorectal cancer screening from a health care provider, and whether this difference has changed over time. METHOD: Secondary analysis of the 2002, 2004, 2006, and 2008 Maryland Cancer Surveys, cross-sectional population-based random-digit-dial surveys on cancer screening. Participants were 11,368 White and 2495 Black Maryland residents age ≥ 50 years. RESULTS: For each race, recommendations for colonoscopy/sigmoidoscopy increased over time (67%-83% for Whites, 57%-74% for Blacks; p<0.001 for both), but the race difference remained approximately 10% at each survey. Among respondents without a colonoscopy in the last 10 years (n=5081), recommendations for fecal occult blood test (FOBT) in the past year decreased over time for Whites (37%-24%, p<0.001) and for Blacks (36-28%, p=0.05), with no difference by race in any year. In multivariable analysis, the effect of race on the odds of reporting a provider recommendation did not vary significantly across time for either test (p=0.80 for colonoscopy/sigmoidoscopy, p=0.24 for FOBT for effect modification by year). CONCLUSION: Whites were more likely than Blacks to report ever receiving a provider recommendation for colonoscopy/sigmoidoscopy. Although the proportion of patients receiving recommendations for colonoscopy/sigmoidoscopy increased over time, the gap between races remained unchanged.

Measuring health behaviors and landline telephones: potential coverage bias in a low-income, rural population.

OBJECTIVES: Population-based landline telephone surveys are potentially biased due to inclusion of only people with landline telephones. This article examined the degree of telephone coverage bias in a low-income population. METHODS: The Charles County Cancer Survey (CCCS) was conducted to evaluate cancer screening practices and risk behaviors among low-income, rural residents of Charles County, Maryland. We conducted face-to-face interviews with 502 residents aged 18 years and older. We compared the prevalence of health behaviors and cancer screening tests for those with and without landline telephones. We calculated the difference between whole sample estimates and estimates for only those respondents with landline telephones to quantify the magnitude of telephone coverage bias. RESULTS: Of 499 respondents who gave information on telephone use, 80 (16%) did not have landline telephones. We found differences between those with and without landline telephones for race/ethnicity, health-care access, insurance coverage, and several types of cancer screening. The absolute coverage bias ranged up to 6.5 percentage points. Simulation scenarios showed the magnitude of telephone coverage bias decreases as the percent of the population with landline telephone coverage increases, and as landline telephone coverage increases, the estimates from a landline telephone survey would approximate the estimates from a face-to-face survey. CONCLUSIONS: Our findings highlighted the need for targeted face-to-face surveys to supplement telephone surveys to more fully characterize hard-to-reach subpopulations. Our findings also indicated that landline telephone-based surveys continue to offer a cost-effective method for conducting large-scale population studies in support of policy and public health decision-making.

Oral cancer exams among cigarette smokers in Maryland.

BACKGROUND: Current and former smokers are at increased risk to develop oral cancer. This analysis was performed to determine whether current and former smokers are more likely to undergo an exam for oral cancer than non-smokers. METHODS: The Maryland Cancer Survey performed in 2002 was a population-based random digit dial, statewide survey on cancer screening and risk behaviors, targeting adults aged 40 years and older. The dataset contains self-reported information on oral cancer examinations, current smoking status, and health care access information for 4840 Maryland residents. RESULTS: 2062 (42.6%) of Marylanders aged 40 years and older reported ever having had an oral cancer examination. Dentists and dental hygienists performed 90.9% of the exams. Current and former smokers were no more likely than those who have never smoked to have ever had the examination (adjusted OR = 1.02, 95% CI = 0.85-1.23 and OR = 1.09, 95% CI = 0.94-1.25, respectively). Other predictors associated with having an oral cancer exam included having more than a high school of education, being female, non-black, being in good to excellent health, and having a recent physical exam. Having visited the dentist in the last year had the highest odds of having ever had an oral cancer exam. CONCLUSIONS: Current and former smokers are a high-risk group who need to be targeted for oral cancer exams by dental professionals and primary care physicians.

Body mass index and up-to-date colorectal cancer screening among Marylanders aged 50 years and older.

INTRODUCTION: Overweight and obese individuals are at increased risk for developing and dying from colorectal cancer. Studies suggest that overweight and obese women are more likely to avoid or delay cancer screening. Our objective was to determine whether overweight or obese adults aged 50 years and older living in Maryland in 2002 were less likely to be up-to-date with colorectal cancer screening than normal and underweight adults. METHODS: The relationship between body mass index and colorectal cancer screening was evaluated based on responses from 3436 participants aged 50 years and older to the Maryland Cancer Survey 2002, a population-based random-digit-dial telephone survey. The survey contains self-reported information on colorectal cancer screening, height, weight, and potential confounders. Logistic regression was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for age, sex, race, employment, marital status, education, area of residence, and health-care-related variables. RESULTS: Overall, 64.9% of Marylanders aged 50 and older were up-to-date with colorectal cancer screening. Compared with normal and underweight individuals, overweight individuals had similar odds of being up-to-date with colorectal cancer screening (OR, 1.05; 95% CI, 0.83-1.33). Obese individuals had slightly lower odds, but this difference was not statistically significant (OR, 0.84; 95% CI, 0.65-1.09). Recommendation by a health care provider for colorectal cancer screening was strongly associated with up-to-date colorectal cancer screening (OR, 36.7; 95% CI, 28.7-47.0). CONCLUSION: Our study shows no statistically significant association between body mass index levels and up-to-date colorectal cancer screening. We recommend that physicians and other health care providers increase up-to-date colorectal cancer screening rates in the population by referring their patients for appropriate screening.