Background
The Centers for Disease Control and Prevention (CDC) funds the Colorectal Cancer Control Program (CRCCP) to increase colorectal cancer (CRC) screening rates in primary care clinics by ...implementing evidence‐based interventions (EBIs). This study examined differences in clinic characteristics and implementation efforts among clinics with differential changes in screening rates over time.
Methods
CRCCP clinic data collected by the CDC were used. The outcome was the clinic status (highest quartile Q4 vs lowest quartile Q1), which was based on the absolute screening rate change between the first and second program years. Five clinic characteristic variables and 12 clinic‐level CRCCP variables (eg, EBIs) were assessed in bivariable analyses, and logistic regression was used to determine significant predictors of the outcome.
Results
Each group included 78 clinics (N = 156). Clinics with a Q4 status saw a 14.9 percentage point increase in the screening rate, whereas clinics with a Q1 status experienced a 9.1 percentage point decline. Q4s were more likely than Q1s to have a CRC champion, implement 4 EBIs versus fewer EBIs, implement at least 1 new EBI, and increase the number of implemented EBIs. The adjusted odds of Q4 status were 5.3 times greater (95% confidence interval CI, 1.9‐14.9) if a clinic implemented an additional EBI. The adjusted odds of Q4 status increased to 7.1 (95% CI, 2.2‐23.1) if a clinic implemented 2 to 4 additional EBIs.
Conclusions
Implementing new EBIs or enhancing existing ones improves CRC screening rates. Additionally, clinics with lower screening rates had greater rate increases and may have benefited more from the CRCCP.
Implementing new evidence‐based interventions or enhancing existing ones improves colorectal cancer screening rates. Implementing these interventions can lead to a significant increase in colorectal cancer screening rates among low‐income, medically underserved populations.
Heart disease and cancer are the first and second leading causes of death in the United States. Age-standardized death rates (risk) have declined since the 1960s for heart disease and for cancer ...since the 1990s, whereas the overall number of heart disease deaths declined and cancer deaths increased. We analyzed mortality data to evaluate and project the effect of risk reduction, population growth, and aging on the number of heart disease and cancer deaths to the year 2020.
We used mortality data, population estimates, and population projections to estimate and predict heart disease and cancer deaths from 1969 through 2020 and to apportion changes in deaths resulting from population risk, growth, and aging.
We predicted that from 1969 through 2020, the number of heart disease deaths would decrease 21.3% among men (-73.9% risk, 17.9% growth, 34.7% aging) and 13.4% among women (-73.3% risk, 17.1% growth, 42.8% aging) while the number of cancer deaths would increase 91.1% among men (-33.5% risk, 45.6% growth, 79.0% aging) and 101.1% among women (-23.8% risk, 48.8% growth, 76.0% aging). We predicted that cancer would become the leading cause of death around 2016, although sex-specific crossover years varied.
Risk of death declined more steeply for heart disease than cancer, offset the increase in heart disease deaths, and partially offset the increase in cancer deaths resulting from demographic changes over the past 4 decades. If current trends continue, cancer will become the leading cause of death by 2020.
Background: Because total prostate-specific antigen (PSA) and, more recently, the percent free PSA are used to screen men
for prostate cancer, population-based, age- and race-specific distributions ...are needed of both PSA tests among American men
to estimate the effect of lowering the PSA threshold or widespread introduction of the free PSA test as an additional screening
test.
Methods: We did PSA assays on serum samples from men of ages 40 years and older ( n = 1,320) who participated in the 2001-2002 National Health and Nutrition Examination Survey.
Results: About 6.1% (95% confidence interval, 4.7-7.7%), corresponding to an estimated 3.4 million (range, 2.7-4.3 million)
men nationwide, ages 40 years and older, had a total PSA of >4.0 ng/mL. Among men ages 50 to 69 years old, the age group for
which PSA testing is most prevalent, 5.4% or an estimated 900,000 to 2 million men had a total PSA of >4.0 ng/mL. An equal
number had a total PSA between 2.5 and 4.0 ng/mL and a percent free PSA of <25%. Approximately 27% of men in this age group,
corresponding to a range of 5.7 to 8.1 million men, had a total PSA <2.5 ng/mL and a percent free PSA of <25%.
Conclusion: The effect of lowering the total PSA threshold or introducing another screening test is significant. Provision
of the number of U.S. men with certain total PSA and percent free PSA values may help guide prostate cancer public health
policy and screening practices.
Abstract Purpose Screening has been shown to lower the morbidity and mortality for breast, cervical, and colorectal cancers. Despite the availability of cancer screening, nearly 70,000 women die each ...year from these cancers. We conducted a study in 2008 within a privately-insured patient population of women who were members of an integrated health care system in Southeastern Michigan, for whom information on ovarian cancer risk as well as personal and family history of cancer was available. Methods We used a population-based, weighted stratified random sample of women from a single health care institution to assess the proportion with up-to-date breast, cervical, and colorectal screening. Multivariable analyses were conducted to identify predictors of screening behavior. Results In our study, women reported cervical and breast cancer screening above 90% and colorectal cancer screening above 75%. Conclusions The results of our study hold promise that Healthy People 2020 cancer screening objectives might be obtainable as access to health insurance is expanded among US residents.
Purpose This study used population-based data to estimate the percentage of cancer survivors in the United States reporting current medication use for anxiety and depression and to characterize the ...survivors taking this type of medication. Rates of medication use in cancer survivors were compared with rates in the general population. Methods We analyzed data from the National Health Interview Survey, years 2010 to 2013, identifying cancer survivors (n = 3,184) and adults with no history of cancer (n = 44,997) who completed both the Sample Adult Core Questionnaire and the Adult Functioning and Disability Supplement. Results Compared with adults with no history of cancer, cancer survivors were significantly more likely to report taking medication for anxiety (16.8% v 8.6%, P < .001), depression (14.1% v 7.8%, P < .001), and one or both of these conditions combined (19.1% v 10.4%, P < .001), indicating that an estimated 2.5 million cancer survivors were taking medication for anxiety or depression in the United States at that time. Survivor characteristics associated with higher rates of medication use for anxiety included being younger than 65 years old, female, and non-Hispanic white, and having public insurance, a usual source of medical care, and multiple chronic health conditions. Survivor characteristics associated with medication use for depression were largely consistent with those for anxiety, with the exceptions that insurance status was not significant, whereas being widowed/divorced/separated was associated with more use. Conclusion Cancer survivors in the United States reported medication use for anxiety and depression at rates nearly two times those reported by the general public, likely a reflection of greater emotional and physical burdens from cancer or its treatment.
This research explored the relationships between race/ethnicity and area factors affecting access to health care in the United States. The study represents an advance on previous research in this ...field because, in addition to including data on rurality, it incorporates additional contextual covariates describing aspects of health care accessibility. Individual-level data were obtained from the 2002 Behavioral Risk Factor Surveillance System (BRFSS). The county of residence reported by BRFSS respondents was used to link BRFSS data with county-level measures of health care access from the 2004 Area Resource File (ARF). Analyses of mammography were limited to women aged ⩾40 years with known county of residence (
n=91,492). Analyses of Pap testing were limited to women aged ⩾18 years with no history of hysterectomy and known county of residence (
n=97,820). In addition to individual-level covariates such as race, Hispanic ethnicity, health insurance coverage and routine physical exam in the previous year. We examined county-level covariates (residence in health professional shortage area, urban/rural continuum, racial/ethnic composition, and number of health centers/clinics, mammography screening centers, primary care physicians, and obstetrician-gynecologists per 100,000 female population or per 1000 square miles) as predictors of cancer screening. Both individual-level and contextual covariates are associated with the use of breast and cervical cancer screening. In the current study, covariates associated with health care access, such as health insurance coverage, household income, Black race, and percentage of county female population who were non-Hispanic Black, were important determinants of screening use. In multivariate analysis, we found significant interactions between individual-level covariates and contextual covariates. Among women who reside in areas with lower primary care physician supply, rural women are less likely than urban women to have had a recent Pap test. Black women were more likely than White women to have had a recent Pap test. Women with a non-rural county of residence were more likely to have had a recent mammogram than rural women. A significant interaction was also found between individual-level race and number of health centers or clinics per 100,000 population (
p-value=0.0187). In counties with 2 or more health centers or clinics per 100,000 female population, Black women were more likely than White women to have had a recent mammogram. A significant interaction was also observed between the percentage of county female population who were Hispanic and the percentage who were non-Hispanic Black.
To examine the various concerns of patients after being diagnosed with cancer as well as the availability of information to address concerns from the time of diagnosis to the completion of treatment, ...we analyzed data from a longitudinal study of 731 adults recently diagnosed with cancer. Concerns about the effectiveness and side effects of treatment and family stress were most common after diagnosis. Information about the diagnosis and treatment plan was readily available to patients, but information addressing social, lifestyle, and financial concerns was less available. Significantly more information was desired regarding the long-term implications of treatment and disease.
In 2005, the United States Preventive Services Task Force (USPSTF) released guidelines which outlined specific family history patterns associated with an increased risk for BRCA1/2 mutations, and ...recommended at-risk individuals be referred for genetic counseling and evaluation for BRCA testing. The purpose of this study was to assess the prevalence of individuals with a USPSTF increased-risk family history pattern, the frequency with which specific patterns were met, and resulting healthcare actions among women from the Henry Ford Health System.
As part of a study evaluating ovarian cancer risk perception and screening, 2,524 randomly selected participants completed a detailed interview (response rate 76%) from an initial eligible cohort of 16,720 women.
Approximately 6% of participants had a family history fulfilling one or more of the USPSTF patterns. Although 90% of these women had shared their family history with their provider, less than 20% had been referred for genetic counseling and only 8% had undergone genetic testing. Caucasian women with higher income and education levels were more likely to receive referrals. Among the 95 participants in the total study cohort who reported BRCA testing, 78% did not have a family history that met one of the USPSTF patterns.
These results suggest a higher prevalence of women with an increased-risk family history than originally predicted by the USPSTF, and lack of provider recognition and referral for genetic services.
Improvements in healthcare infrastructure and clinician education will be required to realize population level benefits from BRCA genetic counseling and testing.
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