Patterns and Trends in Cancer Screening in the United States

Abstract

Introduction: We examined the prevalence of cancer screening reported in 2015 among US adults, adjusted for important sociodemographic and access-to-care variables. By using data from the National Health Interview Survey (NHIS) for 2000 through 2015, we examined trends in prevalence of cancer screening that adhered to US Preventive Services Task Force screening recommendations in order to monitor screening progress among traditionally underserved population subgroups.

Methods: We analyzed NHIS data from surveys from 2000 through 2015 to estimate prevalence and trends in use of recommended screening tests for breast, cervical, colorectal, and prostate cancers. We used logistic regression and report predictive margins for population subgroups adjusted for various socioeconomic and demographic variables.

Results: Colorectal cancer screening was the only test that increased during the study period. We found disparities in prevalence of test use among subgroups for all tests examined. Factors that reduced the use of screening tests included no contact with a doctor in the past year, no usual source of health care, and no insurance coverage.

Conclusion: Understanding use of cancer screening tests among different population subgroups is vital for planning public health interventions with potential to increase screening uptake and reduce disparities in cancer morbidity and mortality. Overarching goals of Healthy People 2020 are to "achieve health equity, eliminate disparities, and improve the health of all groups." Adjusted findings for 2015, compared with previous years, show persistent screening disparities, particularly among the uninsured, and progress for colorectal cancer screening only.

Figure 1

Progress toward meeting Healthy People 2020 cancer screening targets (2), National Health Interview Survey (NHIS) 2008 and 2015 estimates of cancer screening test use based on US Preventive Services Task Force recommendations: Papanicolaou test among women aged 21 to 65 in past 3 years, mammogram among women 50 to 74 within past 2 years, colorectal cancer tests among adults aged 50 to 75 years (fecal occult blood test [FOBT] within past year or flexible sigmoidoscopy past within 5 years and FOBT within past 3 years or colonoscopy within past 10 years). Healthy People 2020 targets represent improvements over 2008 baseline age-adjusted screening levels of 10% for Papanicolaou test, 10% for mammography, and 35% for colorectal cancer testing. Brackets indicate gap between NHIS 2015 reported screening and Healthy People 2020 targets. Abbreviation: NA, not applicable. [Table: see text]

Figure 2

Trends in use of cancer screening tests among women and men, National Health Interview Survey, 2000–2015 (www.cdc.gov/nchs/nhis/index.htm). A. Prevalence of having a Papanicolaou test within past 3 years among women aged 20 to 65. B. Prevalence of having a mammogram among women aged 50 to 74 within past 2 years. C. Prevalence of having a recent colorectal cancer test among women aged 50 to 75 (for colorectal cancer tests, recent is defined as having a fecal occult blood test [FOBT] in the past year, flexible sigmoidoscopy in past 5 years with FOBT in past 3 years, or colonoscopy in past 10 years). D. Prevalence of having a recent colorectal cancer test, by insurance coverage, among men aged 50 to 75. E. Prevalence of having a PSA test among men aged 50 and older. Estimates were adjusted for age, education, poverty, usual source of care, type of health insurance, race/ethnicity, length of US residency, physician visit in the past year, and among women, OB/GYN visit in the past year. Abbreviations: ED, emergency department; PSA, prostate-specific antigen.