Health statistics data reveals trends, factors in the use of cancer screening tests

December 17, 2002

Two decades of national cancer screening data indicate that the use of all screening tests has increased since the 1980s, with the most dramatic increases seen in the use of mammography, according to a review article in the December 18 issue of the Journal of the National Cancer Institute. The data also highlight factors, such as sociodemographic status, source of health care, and knowledge of cancer risk factors, that have been found to influence rates of screening.

The National Health Interview Survey (NHIS), which is directed by the National Center for Health Statistics and conducted by the U.S. Census Bureau, collects information on cancer screening estimates through the Cancer Control Modules. These modules can be used by researchers, public health professionals, and policymakers to determine the extent to which established cancer screening tests are used in clinical practice, to identify segments of the population in which these procedures are not widely used, and to make policy decisions.

Robert A. Hiatt, M.D., Ph.D, and his colleagues at the National Cancer Institute examined rates of self-reported cancer screening published in 73 papers that used data from the NHIS. The papers, published between 1980 and 2001, examined trends in screening rates, factors that may influence screening, and linkages or comparisons of NHIS data with other surveys or sources of information.

The authors found that use of all screening tests has increased since 1987, with the most dramatic increases seen in the use of mammography. Between 1987 and 1990, the percentage of women older than 40 years who reported having an annual mammographic examination increased nearly twofold, from 17% to 33%. By 1998, the rate of mammography use had risen to 67%.

Factors associated with screening use included age and sociodemographic status, source of health care, and knowledge of cancer risk factors. For example, older individuals were less likely to be screened for breast and cervical cancers but were more likely to be screened for colorectal cancer than younger individuals, and higher education and income were associated with a greater likelihood of being screened for these three types of cancer. Insurance coverage was consistently associated with use of breast and cervical cancer screening, and women who practiced healthy behaviors or who were more knowledgeable about cancer prevention and cancer risk factors tended to be screened more frequently than women who did not practice such behaviors.

In addition, Hiatt and his colleagues identified areas that could benefit from more research and described how the Cancer Control Modules are integrated with the objectives of and developments in national cancer surveillance research.

"The new Cancer Control [Module] to the 2000 NHIS will provide opportunities not only to explore screening in light of past surveys but also to evaluate use of new or evolving modalities, such as genetic testing, prostate cancer screening, and colorectal cancer screening," they write. "This review of screening data from the NHIS and its Cancer Control supplements has attempted to show what has been learned so far and highlighted areas for further exploration."
Contact: NCI Office of Communications, 301-496-6641; fax: 301-496-0846,

Hiatt R, Klabunde C, Breen N, Swan J, Ballard-Barbash R. Cancer screening practices from national health interview surveys: past, present, and future. J Natl Cancer Inst 2002;94:1837-46.

Note: The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. Attribution to the Journal of the National Cancer Institute is requested in all news coverage.

Journal of the National Cancer Institute

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