Colorectal cancer-screening tests and associated health behaviors.

BACKGROUND: Studies have shown that screening reduces colorectal cancer mortality. We analyzed national survey data to determine rates of use of fecal occult blood testing (FOBT) and sigmoidoscopy, and to determine if these rates differ by demographic factors and other health behaviors. METHODS: A total of 52,754 respondents aged >or=50 years were questioned in the 1997 Behavioral Risk Factor Surveillance System (BRFSS) survey (a random-digit-dialing telephone survey of the non-institutionalized U.S. population) about their use of FOBT and sigmoidoscopy. RESULTS: The age-adjusted proportion of respondents who reported having had a colorectal cancer screening test during the recommended time interval (past year for FOBT and past 5 years for sigmoidoscopy) was 19.8% for FOBT, 30.5% for sigmoidoscopy, and 41.1% for either FOBT or sigmoidoscopy. Rates of use of colorectal cancer screening tests were higher for those who had other screening tests (mammography, Papanicolaou smear, and cholesterol check). There were also differences in rates of use of colorectal cancer screening tests according to other health behaviors (smoking, seat belt use, fruit and vegetable intake, and physical activity) and several demographic factors. However, none of the subgroups that we examined reported a rate of FOBT use above 29% within the past year or a rate of sigmoidoscopy use above 41% within the past 5 years. CONCLUSIONS: While rates of use of FOBT and sigmoidoscopy were higher among people who practiced other healthy behaviors, rates of use were still quite low in all subgroups. There is a need for increased awareness of the importance of colorectal cancer screening.

Colorectal cancer screening participation by older women.

OBJECTIVE: Although recent screening guidelines recommend annual fecal occult blood testing (FOBT) for adults aged > or = 50, a number of studies report that these tests are underused. Systematic efforts to increase awareness of colorectal cancer (CRC) and to promote screening participation are needed to meet national objectives for CRC control. METHODS: This study examined CRC-screening practices and evaluated factors related to recent participation in screening by FOBT in a sample of women aged 50 to 80 who were surveyed about their use of clinical preventive services at Group Health Cooperative, a managed care organization in western Washington State. RESULTS: Of the 931 women eligible for analysis, 75% reported ever having been screened by FOBT and 48% reported having been screened within 2 years before the survey. Participation in screening did not vary by demographic characteristics or by perceived or actual risk of CRC. Women with a positive attitudes toward CRC screening had sevenfold greater odds of recent screening by FOBT (odds ratio=7.1; 95% confidence interval, 4.4 to 11.6). Only 58% of study women reported that their physicians encouraged CRC screening, but this factor was strongly related to participation (odds ratio=12.7; 95% confidence interval, 6.6 to 24.4). CONCLUSIONS: We identified several areas in which understanding of CRC risk may be low. As a whole, these findings suggest that effective strategies to control CRC may include efforts to improve knowledge of risk and prevention, but must also appeal directly to primary care physicians to identify and address their barriers to screening recommendations.

Comparison of self-reported fecal occult blood testing with automated laboratory records among older women in a health maintenance organization.

Screening guidelines for colorectal cancer recommend annual fecal occult blood (FOB) testing for adults aged 50 years and older. Self-reported history of screening is frequently the sole source of data available to researchers and clinicians. This study validated FOB testing in a sample of 1,021 older women. Testing rates based on self-reported data exceeded rates based on computerized laboratory records by 13.9%. Agreement was moderate (kappa = 0.52; 95% confidence interval 0.47, 0.58). Sensitivity was 0.92 and specificity 0.58. Logistic regression analysis showed that older age and physician encouragement for FOB testing were associated with accurate recall (p<0.05). Self-report is the most commonly available information about the occurrence and timing of cancer detection procedures. These data suggest cautious use of self-reported screening by FOB for clinical decision making and for research and surveillance.

Surveillance for use of preventive health-care services by older adults, 1995-1997.

PROBLEM/CONDITION: In 1995, a total of 55 million persons aged > or =55 years lived in the United States. The members of this large and growing segment of the population are major consumers of health care. Their access to medical and dental preventive services contributes to their likelihood of healthy later years and influences their long-term impact on the health-care delivery system. REPORTING PERIOD: 1995-1997. DESCRIPTION OF SYSTEMS: This report summarizes data from the National Health Interview Survey (NHIS), the state-based Behavioral Risk Factor Surveillance System (BRFSS), and the Medicare Current Beneficiary Study (MCBS) to describe national, regional, and state-specific patterns of access to and use of preventive services among persons aged > or =55 years. RESULTS: During 1995-1997, approximately 90% of persons aged > or =55 years living in the United States reported having a regular source of health-care services. However, only 75%-80% reported receiving a routine checkup during the preceding 2 years. The estimated percentage of persons who reported not being able to receive medical care because of cost was highest for those aged 55-64 years. Within this age group, the percentage was highest among Hispanics (4%) and persons without a high school diploma. Approximately 11% of Medicare beneficiaries reported delaying care be cause of cost or because they had no particular source of care. Percentage estimates varied according to age, race/ethnicity, and sociodemographic status. Approximately 95% of persons aged > or =55 years reported having their blood pressure checked during the preceding 2 years, but only 85%-88% had received a cholesterol evaluation during the preceding 5 years. The percentage of women receiving breast and cervical cancer screening decreased with increasing age, and the percentage of persons aged > or =55 years who had received some form of screening for colorectal cancer was low approximately 25% for fecal occult blood testing (FOBT) and 45% for endoscopy. State-specific rates of compliance with vaccination recommendations among persons aged > or =65 years were higher for influenza vaccine (range: 54%-74%) than for pneumococcal vaccine (range: 32%-59%), and compliance increased with advancing age. State-specific estimates of the percentage of annual dental visits varied 40%-75%, and 41%-88% of persons aged > or =65 years reported not having dental insurance. INTERPRETATION: Access to medical services among adults living in the United States is greater for persons aged > or =65 years, compared with those aged <65 years, presumably because of Medicare coverage. In contrast, use of dental services decreased, despite increased need for preventive and restorative dental care. Although Medicare covers many medical services for older adults, financial, personal, and physical barriers to both medical and dental care create racial, regional, and sociodemographic disparities in health status and use of health services in the United States. PUBLIC HEALTH ACTION: Continued surveillance of access to and use of health services among older adults (i.e., persons aged > or =65 years), as well as among persons aged 55-64 years, will help health-care providers target underserved groups, make Medicare coverage decisions, and develop public health programs to ensure equitable access to services and improve the health of older adults.

The National Breast and Cervical Cancer Early Detection Program: report on the first 4 years of mammography provided to medically underserved women.

OBJECTIVE: We describe results from 284,503 mammographic examinations and associated diagnostic workups provided to medically underserved women in an ongoing nationwide breast cancer early detection program. MATERIALS AND METHODS: We report the results of mammographic examinations and diagnostic workups on 230,143 medically underserved women 40 years old or older who underwent at least one mammographic examination from July 1991 through June 1995. Mammograms were obtained in hundreds of mammography and clinical facilities throughout the United States, including community health centers, health department clinics, private practitioners' offices, university based facilities, and mobile mammography units. Our analysis included rates of mammograms with abnormal findings (reported according to the categories of the American College of Radiology Breast Imaging Reporting and Data System), breast cancer detection rates, numbers of diagnostic procedures performed, stage and size distribution of breast cancers, and positive predictive value of mammograms and biopsies with abnormal findings--all presented according to screening round and 10-year age intervals. RESULTS: Mammograms with abnormal findings constituted 5% of mammograms in the first round and 4% in subsequent rounds, both proportions declining by approximately one third from the youngest (40-49 years) to the oldest (70 years and older) age group. Breast cancer detection rates per 1000 mammographic examinations were 5.1 for the first round and 2.0 for subsequent rounds; from the youngest to the oldest age group, the first-round rates doubled and the subsequent-round rates tripled. Early-stage cancers accounted for 54% of first-round cancers and 81% of subsequent-round cancers. Percentage of invasive cancers at least 2 cm in size declined from 51% in the first round to 33% in subsequent rounds: however, we found little change in the proportion of lesions smaller than 1 cm. Positive predictive values declined from 9.5 cancers per 100 mammograms with abnormal findings in the first round to 5.6 cancers per 100 mammograms with abnormal findings in the subsequent rounds. CONCLUSION: A large nationwide breast cancer early detection program conducted through hundreds of diverse facilities has provided results that, although not a statistically representative sample of mammography services, are probably the best available characterization of the current state of breast cancer screening practices as they actually occur in the 1990s in the United States. These results should be useful to clinicians, researchers, and public health personnel in counseling patients, planning new studies, and improving efforts to control breast cancer.

Cervical cancer screening and demonstration projects to identify barriers to preventing cervical cancer mortality.

Cervical cancer screening and demonstration projects to identify barriers to optimal screening are discussed. Interview surveys showed that older women and women in low-income groups tended to have lower rates of Papanicolaou smear screening. Data produced by demonstration projects established by the Centers for Disease Control in collaboration with state and local authorities and private institutions will be used to design and implement strategies for increasing screening levels to further reduce cervical cancer mortality.

Increase in high-grade lymphomas in young men.

The relative frequencies of non-Hodgkin's lymphoma (NHL) subtypes and primary sites of presentation in young men before and during the acquired immunodeficiency syndrome epidemic were studied. Diagnostic pathological specimens were reviewed and classified according to the Working Formulation grades for cases of NHL in men aged 20-49 years identified through a population-based cancer registry. 76% of the lymphomas diagnosed in 1981-82 were intermediate or high grade, compared with 29% of those diagnosed in 1976-77. This increase was still significant when men aged 20-39 years and 40-49 years were grouped separately, and for married men. The proportion of extranodal lymphomas diagnosed in men aged 20-39 years also rose significantly from the early to the later period.

Cytogenetic findings in persons living near the Love Canal.

Cytogenetic analyses were performed on peripheral blood from 46 present or past residents of the area surrounding Love Canal, a former dump site for chemical wastes in Niagara Falls, NY. Participants included 17 persons in whom cytogenetic analyses had been performed in 1980 and 29 persons who had been living in 1978 in seven homes that directly adjoined the canal and in which environmental tests showed elevated levels of chemicals spreading from the canal. Frequencies of chromosomal aberrations and of sister chromatid exchange (SCE) did not differ significantly from control levels. For all participants, cigarette smoking was associated with an increase in sister chromatid exchange frequency.