Patterns of cancer screening in primary care from 2005 to 2010

Authors

  • Kathryn J. Martires MD,

    Corresponding author
    1. Department of Graduate Medical Education, Scripps Mercy Hospital, San Diego, California
    2. Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
    • Corresponding author: Kathryn Martires, MD, Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, 1515 North Vermont Avenue, 5th Floor, Los Angeles, CA 90027; Fax: (323) 783-1629; kathryn.martires@gmail.com

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  • David E. Kurlander BS,

    1. Case Western Reserve University School of Medicine, Cleveland, Ohio
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  • Gregory J. Minwell MD,

    1. Department of Radiology, the Johns Hopkins Hospital, Baltimore, Maryland
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  • Eric B. Dahms MD,

    1. Department of Graduate Medical Education, Scripps Mercy Hospital, San Diego, California
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  • Jeremy S. Bordeaux MD, MPH

    1. Case Western Reserve University School of Medicine, Cleveland, Ohio
    2. Department of Dermatology, University Hospitals Case Medical Center, Cleveland, Ohio
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  • We thank Andrew Lee, BS, for contributing to the statistical analysis and graphic representations in this study.

Abstract

BACKGROUND

Cancer screening recommendations vary widely, especially for breast, prostate, and skin cancer screening. Guidelines are provided by the American Cancer Society, the US Preventive Services Task Force, and various professional organizations. The recommendations often differ with regard to age and frequency of screening. The objective of this study was to determine actual rates of screening in the primary care setting.

METHODS

Data from the National Ambulatory Medical Care Survey were used. Only adult visits to non–federally employed, office-based physicians for preventive care from 2005 through 2010 were examined. Prevalence rates for breast, pelvic, and rectal examinations were calculated, along with the rates for mammograms, Papanicolaou smears, and prostate-specific antigen tests. Factors associated with screening, including age, race, smoking status, and insurance type, were examined using t tests and chi-square tests.

RESULTS

In total, 8521 visits were examined. The rates of most screening examinations and tests were stable over time. Clinical breast examinations took place significantly more than mammography was ordered (54.8% vs 34.6%; P < .001). White patients received more mammography (P = .031), skin examinations (P < .010), digital rectal examinations (P < .010), and prostate-specific antigen tests (P = .003) than patients of other races. Patients who paid with Medicare or private insurance received more screening than patients who had Medicaid or no insurance (P < .010).

CONCLUSIONS

Current cancer screening practices in primary care vary significantly. Cancer screening may not follow evidence-based practices and may not be targeting patients considered most at risk. Racial and socioeconomic disparities are present in cancer screening in primary care. Cancer 2014;120:253–261. © 2013 American Cancer Society.

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