Asians are underutilizing cancer screening tests
A report from the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute finds that the percentage of U.S. citizens screened for cancer is still below national targets, with significant disparities among racial and ethnic populations. Screening rates have been lower among Asians than among whites and blacks.Each year, approximately 350,000 persons are diagnosed with breast, cervical, or colorectal cancer in the United States, and nearly 100,000 die from these diseases. For three decades a document called “Healthy People” has set 10-year national objectives for improving the health of all Americans. The 2010 edition, called “Healthy People 2020,” sets screening goals for the early detection of several types of cancers. Following are the breast, cervical, and colorectal cancer screening recommendations endorsed by the United States Preventive Services Task Force:
• Breast Cancer: Women aged 50-74 years should be screened with a mammogram every two years.
• Cervical Cancer: Women aged 21-65 years should be screened with a Pap test at least every three years. Alternatively, women aged 30-65 years can extend their screening interval to every five years by having a Pap and human papillomavirus testing.
• Colorectal Cancer: Screening is recommended for average-risk men and women aged 50-75 years, using high-sensitivity fecal occult blood test (FOBT), done at home every year; sigmoidoscopy every five years, with high-sensitivity FOBT every three years; or colonoscopy every 10 years.
In 2010 the National Health Interview Survey was used to assess the use of currently recommended cancer screening tests by age, race, ethnicity, education, length of residence in the United States, and the source and financing of health care. Asians taking the survey were classified as Chinese, Filipino, or other Asian.Significant findings for the period 2000-2010 include:
• Breast cancer screening rates remained relatively stable, but only reached 72.4% in 2010, below the Healthy People 2020 target of 81%.
• Cervical cancer screening: Slightly fewer women reported getting a Pap test within the last three years; the 2010 result was 83%, below the 2020 target of 93%.
• Colorectal cancer screening rates increased for men and women, with the rate for women increasing slightly faster so that rates among both sexes were nearly identical (58.5 percent for men and 58.8 percent for women) in 2010, but this total result of 58.6% is still well below the 2020 target of 70.5%.
• Considerably lower breast, cervical, and colorectal cancer screening use was reported by those without any usual source of health care or health insurance.
• Among Asians, screening rates for all three cancers were lower (64.1% for breast cancer, 75.4% for cervical cancer, and 46.9% for colorectal cancer). Immigrant women who had been in the United States for <10 years were almost as likely as U.S.-born women to report having had a mammogram within the past 2 years (70.3% and 73.1%, respectively), whereas only 46.6% of immigrants in the United States for <10 years reported being screened in the past 2 years. Education level also was associated positively with screening.
Financial barriers to screening might explain some of the observed disparities in cancer screening rates. Dr. K. Sujatha Reddy, who has worked for years with Georgia Community Health Centers, expanded her reach to the medically underserved by founding the nonprofit Sai Health Fair, Inc. She knows people who have to pay $950/month for health insurance, and the testing she provides at health fairs for a nominal $25 is comparable to testing costing $650 in the healthcare system—so high costs can be a hurdle for many people.
Resources: The National Breast and Cervical Cancer Early Detection Program provides free or low-cost screening and diagnostic breast and cervical cancer services to low-income, underinsured, and uninsured women, and access to state Medicaid programs for treatment if breast or cervical cancer are diagnosed. The CDCs Colorectal Cancer Control Program funds 25 states and more to implement population-based approaches to increase screening among men and women aged 50 years and older. For information, visit www.cdc.gov/cancer and www.cancer.gov.
The Affordable Care Act is expected to reduce financial barriers to screening by expanding insurance coverage. Breast, cervical, and colorectal cancer screening are now covered free in Medicare and in newly offered private insurance plans. State Medicaid programs that provide these services free will receive an enhanced federal match rate.
Other efforts are needed, such as developing systems that identify persons eligible for cancer screening tests, actively encouraging the use of screening tests, and monitoring participation to improve screening rates.
[Please email your health and medical questions for consideration in this column to: gharjee@comcast. net. The material in this column is of a general nature, and must not be construed as specific medical advice.]
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Healthy People 2020
A related report from the American Cancer Society, 2010
National Breast and Cervical Cancer Early Detection Program (NBCCEDP)
Colorectal Cancer Control Program
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