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Preventive health exams may provide opportunities for cancer screening

March 27, 2007

Health plan members who receive preventive health examinations, as opposed to going to a physician only when they are sick, appear more likely to undergo testing for colorectal, breast and prostate cancers, according to a report in the March 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Preventive or periodic health examinations—also called well visits, health maintenance visits or general medical examinations—have been part of medical practice since at least the middle of the 19th century, according to background information in the article. These examinations generally include a medical history and a physical examination and may also include screening, counseling or immunizations. "The preventive health examination may be an auspicious time to promote cancer screening," the authors write. "The preventive health examination may afford primary care physicians the opportunity to discuss and recommend cancer screening when indicated, and physicians' recommendations have been consistently associated with timely cancer screening."

Joshua J. Fenton, M.D., M.P.H., University of California, Davis, Sacramento, and colleagues assessed the association between preventive health examinations and screening for colorectal, breast or prostate cancer in 64,288 enrollees of a Washington State health plan in 2002 to 2003. This included 39,475 patients eligible for colorectal cancer screening, 31,379 women eligible for breast cancer screening and 28,483 men eligible for prostate cancer screening. The patients were between the ages of 52 and 78, and all visited their primary care physician at least once during the study period.

More than half (52.4 percent) of the patients received a preventive health examination in 2002 or 2003. After the researchers controlled for other factors influencing cancer screening rates, including patient demographic characteristics and historical use of medical care, eligible patients who received preventive health examinations were significantly more likely than those who did not receive them to undergo testing for colorectal cancer (57.2 percent vs. 17.2 percent), breast cancer screening mammography (74.1 percent vs. 55.9 percent) and prostate cancer PSA testing (58.8 percent vs. 21.1 percent). "The associations were particularly strong for colorectal cancer and prostate cancer, for which the health plan provides no centralized screening program," as it does for mammography, the authors write.

"In similar populations, the preventive health examination may serve as a clinically important forum for the promotion of evidence-based colorectal cancer and breast cancer screening and of prostate cancer screening, which is not universally recommended," they conclude. "Experimental studies could confirm the efficacy of the preventive health examination in health promotion, elucidate the ideal content of preventive health examinations and guide the development of interventions to help physicians make the most of preventive health examinations."

JAMA and Archives Journals