Are there regional tendencies toward controversial screening practices? A study of prostate and breast cancer screening in a Medicare population

Raffin, Eric; Onega, Tracy; Bynum, Julie; Austin, Andrea M.; Carmichael, Donald; Bronner, Kristen K.; Goodney, Philip P.; Hyams, Elias S.

doi:10.1016/j.canep.2017.07.015

Cited by 8 publications

(12 citation statements)

References 26 publications

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“…Similar to our findings, other literature has described correlations between prostate-specific antigen testing and overall intensity of health care, with concentrations in affluent, White populations. 8 , 54 , 55 Unlike other cancer screenings in which logistics may be more influential, serology-based prostate-specific antigen tests are easily obtained with other blood tests. 55 Cancer screenings may depend on patient preference, which may lead to testing outside of clinical guidelines.…”

Section: Discussionmentioning

confidence: 99%

“… 8 , 54 , 55 Unlike other cancer screenings in which logistics may be more influential, serology-based prostate-specific antigen tests are easily obtained with other blood tests. 55 Cancer screenings may depend on patient preference, which may lead to testing outside of clinical guidelines. 56 Within VHA, we were concerned that persistent testing outside guidelines may be associated with history of Vietnam-era Agent Orange exposure, a risk factor for prostate cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Factors Associated With Low-Value Cancer Screenings in the VHA populations. 8,54,55 Unlike other cancer screenings in which logistics may be more influential, serology-based prostate-specific antigen tests are easily obtained with other blood tests. 55 Cancer screenings may depend on patient preference, which may lead to testing outside of clinical guidelines.…”

Section: Jama Network Open | Health Policymentioning

confidence: 99%

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Factors Associated With Low-Value Cancer Screenings in the Veterans Health Administration

et al. 2021

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IMPORTANCEMost clinical practice guidelines recommend stopping cancer screenings when risks exceed benefits, yet low-value screenings persist. The Veterans Health Administration focuses on improving the value and quality of care, using a patient-centered medical home model that may affect cancer screening behavior. OBJECTIVE To understand rates and factors associated with outpatient low-value cancer screenings. DESIGN, SETTING, AND PARTICIPANTS This cohort study assessed the receipt of low-value cancer screening and associated factors among 5 993 010 veterans. Four measures of low-value cancer screening defined by validated recommendations of practices to avoid were constructed using administrative data. Patients with cancer screenings in 2017 at Veterans Health Administration primary care clinics were included. Excluded patients had recent symptoms or historic high-risk diagnoses that may affect test appropriateness (eg, melena preceding colonoscopy). Data were analyzed from December 23, 2019, to June 21, 2021. EXPOSURES Receipt of cancer screening test. MAIN OUTCOMES AND MEASURES Low-value screenings were defined as occurring for averagerisk patients outside of guideline-recommended ages or if the 1-year mortality risk estimated using a previously validated score was at least 50%. Factors evaluated in multivariable regression models included patient, clinician, and clinic characteristics and patient-centered medical home domain performance for team-based care, access, and continuity previously developed from administrative and survey data. RESULTS Of 5 993 010 veterans (mean [SD] age, 63.1 [16.8] years; 5 496 976 men [91.7%]; 1 027 836 non-Hispanic Black [17.2%] and 4 539 341 non-Hispanic White [75.7%] race and ethnicity) enrolled in primary care, 903 612 of 4 647 479 men of average risk (19.4%) underwent prostate cancer screening; 299 765 of 5 770 622 patients of average risk (5.2%) underwent colorectal cancer screening; 21 930 of 469 045 women of average risk (4.7%) underwent breast cancer screening; and 65 511 of 458 086 women of average risk (14.3%) underwent cervical cancer screening. Of patients screened, low-value testing was rare for 3 cancers, with receipt of a low-value test in 633 of 21 930 of women screened for breast cancer (2.9%), 630 of 65 511 of women screened for cervical cancer (1.0%), and 6790 of 299 765 of patients screened for colorectal cancer (2.3%). However, 350 705 of 4 647 479 of screened men (7.5%) received a low-value prostate cancer test. Patient race and ethnicity, sociodemographic factors, and illness burden were significantly associated with likelihood of receipt of low-value tests among screened patients. No single patient-, clinician-, or clinic-level factor explained the receipt of a low-value test across cancer screening cohorts.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Jama Network Open | Health Policymentioning

confidence: 99%

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Factors Associated With Low-Value Cancer Screenings in the Veterans Health Administration

et al. 2021

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“…26 We selected these variables because they have been associated with receipt of cancer screening, all-cause mortality, or both. 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 There are multiple cognitive measures in the HRS data, and we chose the total cognition summary score (range, 0-35; higher scores indicate better cognition) because it was the most inclusive and comprehensive measure. We added each of these variables to the base model one at a time separately to assess whether each variable, when added, led to attenuation of the adjusted hazard ratio (aHR) for screening.…”

Section: Methodsmentioning

confidence: 99%

Association Between Receipt of Cancer Screening and All-Cause Mortality in Older Adults

et al. 2021

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Key Points Question Is receipt of cancer screening independently associated with 10-year mortality after accounting for comorbidities and function in older adults? Findings In this cohort study of 5342 patients in the Health and Retirement Study, receipt of breast or prostate cancer screening was associated with a lower hazard of 10-year mortality after adjusting for all variables from a prognostic index that included age, comorbidities, and function. Meaning These findings suggest that screening decisions need to be individualized and not solely dependent on mortality prediction.

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“…One method to overcome these constraints is to perform analyses across groups of patients who reside in different regions, taking advantage of well-known regional variation in health care. 16,17 That is, if testing is associated with the decision to observe prostate cancer, we would expect overall increasing use of observation in areas where testing has increased. In this analysis, we use complementary approaches aimed at triangulating effect estimates conducted at the patient and regional levels.…”

Section: Introductionmentioning

confidence: 99%

Adoption of New Risk Stratification Technologies Within US Hospital Referral Regions and Association With Prostate Cancer Management

et al. 2021

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IMPORTANCEThe clinical decisions that arise from prostate magnetic resonance imaging (MRI) and genomic testing in patients with prostate cancer are not well understood. OBJECTIVETo evaluate the association between regional uptake of prostate MRI and genomic testing and observation vs treatment for prostate cancer. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study of commercial insurance claims for prostate MRI and genomic testing included 65 530 patients 40 to 89 years of age newly diagnosed with prostate cancer from July 1, 2012, through June 30, 2019.EXPOSURES Patient-and regional-level use of prostate MRI and genomic testing. MAIN OUTCOMES AND MEASURES Observation vs definitive treatment for prostate cancer.Patient-level analyses examined the association between receipt of testing or residing in a hospital referral region (HRR) that adopted testing and observation. In regional-level analyses, the dependent variable was the change in the proportion of patients observed for prostate cancer at the HRR level

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Are there regional tendencies toward controversial screening practices? A study of prostate and breast cancer screening in a Medicare population

Cited by 8 publications

References 26 publications

Factors Associated With Low-Value Cancer Screenings in the Veterans Health Administration

Factors Associated With Low-Value Cancer Screenings in the Veterans Health Administration

Association Between Receipt of Cancer Screening and All-Cause Mortality in Older Adults

Adoption of New Risk Stratification Technologies Within US Hospital Referral Regions and Association With Prostate Cancer Management

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