Delivery of cancer screening: how important is the preventive health examination?

Abstract

Background: Patients and physicians strongly endorse the importance of preventive or periodic health examinations (PHEs). However, the extent to which PHEs contribute to the delivery of cancer screening is uncertain.

Methods: In a retrospective cohort study, we determined the association between receipt of a PHE and cancer testing in a population-based sample of enrollees in a Washington State health plan who were aged 52 to 78 years and eligible for colorectal, breast, or prostate cancer screening in 2002-2003 (N = 64 288). Outcomes included completion of any colorectal cancer testing (fecal occult blood testing, sigmoidoscopy, colonoscopy, or barium enema), screening mammography, and prostate-specific antigen testing.

Results: More than half (52.4%) of the enrollees received a PHE during the study period. After adjusting for demographics, comorbidity, number of outpatient visits, and historical preventive service use before January 1, 2002, receipt of a PHE was significantly associated with completion of colorectal cancer testing (incidence difference, 40.4% [95% confidence interval (CI), 39.4%-41.3%]; relative incidence, 3.47 [95% CI, 3.34-3.59]), screening mammography [incidence difference, 14.2% [95% CI, 12.7%-15.7%]; relative incidence, 1.23 [95% CI, 1.20-1.25]), and prostate-specific antigen testing (incidence difference, 39.4% [95% CI, 38.3%-40.5%]; relative incidence, 3.06 [95% CI, 2.95-3.18]).

Conclusions: Among managed care enrollees eligible for cancer screening, PHE receipt is associated with completion of colorectal, breast, and prostate cancer testing. In similar populations, the PHE may serve as a clinically important forum for the promotion of evidence-based colorectal cancer and breast cancer screening and of screening with relatively less empirical support, such as prostate cancer screening.

Figure

Adjusted incidence of any colorectal cancer tests (A), screening mammography (B), and prostate-specific antigen tests (C) in patients who did and did not receive preventive health examinations (PHEs) by the total number of outpatient visits (2002–2003). Incidence is adjusted for age (5-year categories), sex (for colorectal cancer testing), comorbidity (Charlson comorbidity index score of 0, 1, 2, or ≥3), historical PHE receipt (in 2000–2001), number of target organ cancer tests in 2000–2001 (0, 1, or ≥2), benign prostatic hyperplasia diagnosis in 2000–2003 (for prostate-specific antigen testing), and significant interactions between PHE receipt and the listed covariates (P<.05). For each cancer test, likelihood ratio tests of the interaction between PHE receipt and the number of outpatient visits were significant (P<.001).