Evaluating Screening Participation, Follow-up, and Outcomes for Breast, Cervical, and Colorectal Cancer in the PROSPR Consortium

Abstract

Background: Cancer screening is a complex process encompassing risk assessment, the initial screening examination, diagnostic evaluation, and treatment of cancer precursors or early cancers. Metrics that enable comparisons across different screening targets are needed. We present population-based screening metrics for breast, cervical, and colorectal cancers for nine sites participating in the Population-based Research Optimizing Screening through Personalized Regimens consortium.

Methods: We describe how selected metrics map to a trans-organ conceptual model of the screening process. For each cancer type, we calculated calendar year 2013 metrics for the screen-eligible target population (breast: ages 40-74 years; cervical: ages 21-64 years; colorectal: ages 50-75 years). Metrics for screening participation, timely diagnostic evaluation, and diagnosed cancers in the screened and total populations are presented for the total eligible population and stratified by age group and cancer type.

Results: The overall screening-eligible populations in 2013 were 305 568 participants for breast, 3 160 128 for cervical, and 2 363 922 for colorectal cancer screening. Being up-to-date for testing was common for all three cancer types: breast (63.5%), cervical (84.6%), and colorectal (77.5%). The percentage of abnormal screens ranged from 10.7% for breast, 4.4% for cervical, and 4.5% for colorectal cancer screening. Abnormal breast screens were followed up diagnostically in almost all (96.8%) cases, and cervical and colorectal were similar (76.2% and 76.3%, respectively). Cancer rates per 1000 screens were 5.66, 0.17, and 1.46 for breast, cervical, and colorectal cancer, respectively.

Conclusions: Comprehensive assessment of metrics by the Population-based Research Optimizing Screening through Personalized Regimens consortium enabled systematic identification of screening process steps in need of improvement. We encourage widespread use of common metrics to allow interventions to be tested across cancer types and health-care settings.

Figure 1.

Populations for calculating 2013 cancer screening metrics. The figure shows the Population-based Research Optimizing Screening through Personalized Regimens conceptual model adapted from Beaber et al. (15). The operational definition for each metric is illustrated based on the relevant step of the screening process. *Screening tests include mammography (breast), Papanicolaou (Pap) or Pap/human papillomavirus (cervical), and fecal occult blood tests or fecal immunochemical tests, sigmoidoscopy, or colonoscopy (colorectal). †For cervical and colorectal detected abnormalities, excisional treatment may precede surveillance. ‡Duration depends on cancer type and screening modality. Specific components for each metric are detailed in Table 1.

Figure 2.

Percentage of the Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) population screened in 2013 by cancer type. The figure shows one metric, percentage of the population screened in the calendar year 2013, for the three types of cancer screening: A) breast, B) cervical, and C) colorectal. Within each cluster, the percentage screened is given over all age groups and then by each age group. The clusters are all sites combined, followed by each PROSPR research site.

Figure 3.

Percentage of the age-eligible Population-based Research Optimizing Screening through Personalized Regimens population who was up-to-date with breast, cervical, or colorectal cancer testing compared with data from self-report. The figure compares the percentage of the population up-to-date on testing compared with survey-based derived results from the 2015 National Health Interview Survey (NHIS) (7) and from the 2015 Behavioral Risk Factor Surveillance System (BRFSS) survey (29).