The study reviewed here found that only about half of people who received health care through the North Carolina Medicaid program had proper screenings for colorectal, breast, and cervical cancer. In most cases, people weren't screened because doctors weren't suggesting screening tests as recommended by national guidelines.
Only 60% of women in the study who should have had a mammogram actually were sent for a mammogram. Overall, only about 32% of the women had a mammogram within 2 years, whether or not it was recommended.
Researchers reviewed the medical records of nearly 2,000 people age 50 or older who had seen their primary care doctor during a 6-month period in 2006. Since all of the women were 50 or older, all of them should have had a mammogram done within 2 years.
The researchers aren't sure why doctors in this study didn't recommend mammograms as they should. It's also not clear why most of the women didn't get mammograms as they should, even when a mammogram was recommended by a doctor.
Other research has shown that disparities in breast cancer screening and care can be related to factors such as age, race, economic and educational status, access to consistent primary health care, and insurance coverage. In this study, all of the Medicaid patients had consistent access to primary care and mammograms were fully covered. Some other research has shown that African American women are less likely than white women to get recommended mammograms. But in this study, African American women were more likely than white women to get a mammogram.
A long-standing relationship with a primary care doctor strongly influenced the likelihood that people in the study would get cancer screenings as they should. People who saw the same primary care doctor for 5 or more years were about 2.5 times more likely to get recommended cancer screenings compared to people who saw the same primary care doctor for fewer than 2 years. Other research has shown that people get better care when they have a "medical home" -- a primary care doctor or group of doctors who oversee all medical care over a long period of time.
No matter your personal circumstances, skipping regular mammograms is NOT an option if you're older than 40. Stick with the mammogram screening plan you and your doctor decide is best for you. If your doctor doesn't talk about screening or send you for a mammogram, speak up and ask for the referral you need.
There's only one of YOU and you deserve the best care possible -- including regular mammograms.
CHAPEL HILL, N.C., Oct. 13 (MedPage Today) -- Only about half of older Medicaid patients receive recommended screening for colorectal, breast, and cervical cancers, largely because their physicians don't recommend the tests, researchers here reported.
Primary care physicians recommended colorectal cancer screening for only 52.7% of eligible patients, C. Annette DuBard, M.D., M.P.H., of the North Carolina Department of Health and Human Services and the University of North Carolina, and colleagues reported in the Oct. 13 issue of the Archives of Internal Medicine.
Only 60.4% of eligible patients were sent for mammography and only 51.5% for cervical cancer screening.
"Lack of a screening recommendation by the physician, rather than patient refusal of recommended tests, accounted for most instances of screening delinquency," the authors said.
The North Carolina Division of Medical Assistance reviewed medical records for 1,951 North Carolina Medicaid recipients ages 50 and older in the offices of their primary care physicians between March 29, 2006 and Aug. 31, 2006.
Adequate screening for colorectal cancer was documented 28.2% of the time, mammography within two years, 31.7% of the time, and Pap test within three years 31.6%.
About half of eligible Medicaid patients had evidence of screening when medical record and claims data were analyzed together.
Previous studies have shown that Medicaid recipients are more likely to have an advanced stage of cancer at the time of diagnosis than patients with other sources of health insurance, the researchers said.
And other studies have found that patients with lower socioeconomic status have lower rates of cancer screening.
All patients in this study, however, had "access to primary care and full coverage of cancer screening services under Medicaid," the researchers said.
Excluding 52 patients with a previous diagnosis of colon cancer, 52.7% (95% CI 42% to 63.5%) of eligible patients had a documented recommendation for screening. Only 28.2% (95% CI 22.4% to 34%) were screened, most by colonoscopy (81.2%, or 442 of 544 patients).
The authors said this means that alternative screening options for colon cancer screening, like fecal occult blood testing, have not been effectively used in this population.
The odds of being screened for colon cancer were positively associated with length of the patient-primary care physician relationship (OR 2.52, 95% CI 1.46 to 4.37 for a relationship of five years or longer).
For breast cancer, 60.4% (95% CI 51.3% to 69.6%) had a documented recommendation for mammography, but only 31.7% (95% CI 25.4% to 38%) had had a mammogram within two years.
In a multivariate analysis, African-American women were more likely to be screened for breast caner than white women (OR 1.51, 95% CI 1.02 to 2.23).
And similar to the results with colon cancer screening, those who had been seeing their primary care physicians for five years or longer were more likely to be screened than those with a relationship of less than two years (OR 2.40, 95% CI 1.33 to 4.34).
Taken with the colon cancer screening results, "this finding underscores the value of a stable medical home in achieving national objectives for receipt of preventive services," the authors said.
For cervical cancer testing, about half of the women in the study between ages 50 and 64 had had a prior hysterectomy, but of the remaining 465 eligible patients, 51.5% were recommended for a Pap test (95% CI 41.6% to 61.3%). Only 31.6% (95% CI 24.5% to 38.8%) had documentation of a Pap test within the past three years.
African-American women were again more likely to have been screened than white women (39.6% versus 25.5%, P=0.04).
The authors said the finding that African-American women had the highest rates of mammography and Pap screening was "unexpected," and suggested that "racial differences in cancer screening may be unmasked within this low-income population."
The authors said their study differs from other studies on screening rates because data were obtained directly from primary care physicians' medical records rather than by self-report or health plan administrative data.
However, they said they were limited by the fact that they relied on the "completeness, quality, and readability of the documentation" they analyzed.
Although there is said to be widespread endorsement of U.S. Preventive Services Task Force cancer screening guidelines, the authors said there's a need to improve the current rates of cancer screening, especially in this population.
Future efforts could include making organizational changes in staffing and clinic procedures, like using planned care visits or dedicated nonphysician staff, or "using administrative data to identify and reach out to patients in need of preventive services."
The authors reported no disclosures.
Primary source: Archives of Internal Medicine Source reference: DuBard CA, et al "Recommendation for and receipt of cancer screenings among Medicaid recipients 50 years and older" Arch Intern Med 2008; 168(18): 2014-2021.
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