Predictors of Screening for Breast, Cervical, Colorectal, and Prostatic Cancer Among Community-Based Primary Care Practices

Abstract

Background: As we enter the year 2000, it is worth looking at whether primary care practices are reaching the goals established In Healthy People 2000 for breast, cervical, colorectal, and prostatic cancer screening. The objectives of this study were (1) to detennine the current rates of cancer screening; and (2) to detennine which factors predict completion of a single screening test, of all tests for each cancer, and of all procedures for age and sex.Methods: Medical records of 200 eligible patients (100 men and 100 women) from each of 24 community-based primary care practices were abstracted for cancer-screening events.Results: We audited 5125 charts. A Papanicolaou smear was documented for 63.8% of women with an intact cervix within 3 years of the audit .. We found that 46.8% of women had documentation of ever having a discussion of breast self-examination. For breast cancer screening, 41.8% of the women had a clinical breast examination within 1 year, 48.2% aged 40 to 49 years had a mammogram within 2 years, and 38.5% aged 50 years and older had a mammogram within 1 year. Only 29% of women aged 40 to 49 years and 17% of women 50 years and older were current for all breast cancer-screening tests. Among patients 50 years and older, 33% of men and 38% of women had a digital rectal examination within 1 year, 26% of men and 28% of women had a fecal occult blood test within 1 year, and 22% of men and 16.8% of women had a Oexible sigmoidoscopy within 5 years. Of all men 28.7% had a prostate-specific antigen test within 1 year. Completion of all tests relevant for age and sex were documented for 8.6% of women aged 40 to 49 years, 3% of women 50 years and older, and 5% of men 50 years and older. The single most Significant predictor of documented cancer screening was a health maintenance visit.Conclusions: This sample of primary care clinicians has not reached the goals set in Healthy People 2000 for cancer screening. Interventions aimed at increasing the percentage of patients who schedule a health maintenance visit could serve to increase cancer screening and help us reach goals set for the year

Barriers of and Facilitators to Physician Recommendation of Colorectal Cancer Screening

“…This is consistent with 3 previous studies that demonstrate that health maintenance visits are a significant predictor of cancer screening. [45][46][47] Thus, a modifiable system intervention is to reimburse providers for the time spent on preventive health counseling similar to the Medicare Part B "Welcome to Medicare" physical, which reimburses providers for a visit devoted to education and counseling about the preventive services. 48 In addition, financial incentives provided by insurers to patients for completion of age-appropriate screening, as discussed by one of the participating physicians above, have been shown to be an effective intervention for increasing patient request of CRCS.…”

The association between oral contraceptive use and lobular and ductal breast cancer in young women

“…28 All information about oral contraceptive use and other covariates refers to exposures prior to the reference date, which was defined as the age at diagnosis for cases or age at telephone screening interview for controls. Oral contraceptive use variables were created based on categories used in previously published studies.…”

When there is too much to do

“…[1][2][3][4][5][6] However, discussions of the "quality gap" sometimes do not acknowledge that for many common chronic diseases, such as coronary artery disease and diabetes, the number of interventions recommended by expert panels and guidelines is proliferating and threatens to overwhelm providers, not to mention potentially greatly surpassing the time and energy that patients are willing to expend on their health care. For example, Yarnall et al determined that just to carry out the health care maintenance interventions recommended by the U.S. Preventive Services Task Force (USPSTF) for a panel of patients would take a physician close to 8 hours per day of practice, leaving no time for addressing any of the acute complaints or chronic disease management of their patient population.…”