US Cancer Screening Below National Targets

The percentage of people screened for cancer in the US remains below national targets for 2020, with rates lower among Asian and Hispanic Americans than other groups, according to a new report by the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI) released on Friday.

The report shows that in 2010, the screening rate for breast cancer was 72.4%, compared to the 2020 national target of 81%, for cervical cancer it was 83%, compared to a target of 93%, and for colorectal it was 58.6% percent, compared to a target of 70.5%.

The US Preventive Services Task Force (USPSTF), an independent panel of health professionals, recommends screening tests for breast, cervical and colorectal cancers. As part of its Healthy People 2020, the US Department of Health and Human Services has set 10-year national targets for such recommended tests, and identifies the National Health Interview Survey (NHIS) as the way to measure progress.

For breast, cervical and colorectal cancer screening, the USPSTF recommends that:

• Women aged 50 to 74 years have a mammogram every two years,
• Women who have been sexually active or aged 21 to 65 years have a Pap test at least every three years, and
• Average-risk men and women aged 50 - 75 years, should either (1) do a high-sensitivity fecal occult blood test (FOBT) at home every year; (2) undergo sigmoidoscopy every five years with FOBT every three years; or (3) undergo colonoscopy every 10 years.

Data from the NHIS allows researchers to assess people's use of currently recommended screening tests by age, race, ethnicity, education, how long they have lived in the US, and who funds the screening.

The ethnic groups are: Chinese, Filipino, or other Asian and Hispanics as Puerto Rican, Mexican, Mexican-American, Central or South American, or other Hispanic.

The data for 2010 shows that screening rates for all three cancers were significantly lower among Asians: 64.1% breast cancer, 75.4% for cervical, and 46.9% for colorectal), and that non-Hispanics were more likely to be screened for cervical and colorectal cancer (83.8% and 59.9% respectively) than Hispanics (78.7% and 46.5%).

Other key findings include:

• Screening rates for breast cancer haven't changed much in the last 10 years (varied by 3% between 2000 and 2010).


• However, screening rates for colorectal cancer have risen markedly for men and women in the last ten years, with rates for women rising a bit faster, such that by 2010 they were on a par (58.5% for men and 58.8% for women in 2010).


• There was a small but significant 3.3% reduction in rate of women receiving a Pap test in the last three years.


• Rates of screening for all three cancers were significantly lower among those without the usual source of health care or health insurance.

Report lead author Dr Sallyann Coleman King, an epidemic intelligence service officer in the Division of Cancer Prevention and Control at the CDC, told the press she and her colleagues were troubled that not all Americans were getting the recommended cancer screening and that disparities across groups persist:

"Screening can find breast, cervical, and colorectal cancers at an early stage when treatment is more effective. We must continue to monitor cancer screening rates to improve the health of all Americans," she urged.

The authors conclude the findings reinforce the importance of continuing to monitor disparities across groups, and suggest there is a need for new ways to identify people eligible for cancer screening and more effort needs to go into encouraging its use.

They also note that the Affordable Care Act is expected to improve access to screening by expanding insurance coverage.