Adherence to Cancer Screening

Over the years, substantial research has been conducted to understand people’s barriers to cancer screening. Several lessons are clear. First, physician recommendations are the most important factor in motivating people t to be screened. Even then, however, many people will not get necessary tests. Several reviews show that simple reminders and letters, delivered in print or by telephone, can double or triple the odds that people will attain needed tests. This is true even among vulnerable populations. Interventions often are needed at several levels: individual, provider, and health system. The Centers of Disease Control and Prevention’s Task Force on Community Preventive Services has reviewed interventions to promote screening and publishes regular updates (http://cdc.gov).

Some people are at risk for being un- or under screened. These include recent immigrants. People without health insurance, people with no usual source of health care, and people with very low incomes. Although age and ethnicity are important determinants for some cancers, this is not the case for others.

The best source of U.S. data on cancer screening practices is the National Health Interview Survey. In the 2000 National Health Interview Survey, 70% of women aged 40 years and older reported having recent mammograms, 82% of women aged 25 and older reported having recent Pap tests, 41% of men and 37.5% of women reported having either an FOBT within the past year or colorectal endoscopy within the past 5 years, and 41% of men aged 50 years and over had a PSA test within the past 5 years. Rates of regular screening for all these tests are considerably lower than reports of recent screening.