Jean A Shapiro

Centers for Disease Control and Prevention, Atlanta, Michigan, United States

Are you Jean A Shapiro?

Claim your profile

Publications (21)129.24 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Gaps in screening quality in community practice have been well documented. The authors examined recommended indicators of screening quality in the Centers for Disease Control and Prevention's Colorectal Cancer Screening Demonstration Program (CRCSDP), which provided colorectal cancer screening and diagnostic services between 2005 and 2009 for asymptomatic, low-income, underinsured, or uninsured individuals at 5 sites around the United States. For each client screened in the CRCSDP, a standardized set of colorectal cancer clinical data elements was collected. Data regarding client age, screening history, risk level, screening test indication, results, and recommendation for the next test were analyzed. For colonoscopies, data were analyzed regarding whether the cecum was reached, bowel preparation was adequate, and identified lesions were completely removed. Overall, 53% of the fecal occult blood tests (FOBTs) (2295 tests) distributed were completed and returned. At the 2 sites with adequate numbers of FOBTs, 77% and 97%, respectively, of clients with positive results received follow-up colonoscopies. Site-specific cecal intubation rates ranged from 90% to 98%. Adenoma detection rates were 32% for men and 21% for women. For approximately one-third of colonoscopies, the recommended interval to the next test was shorter than recommended by national guidelines. At some sites, endoscopists failed to report on the adequacy of bowel preparation and completeness of polyp removal. Cecal intubation rates and adenoma detection rates met recommended levels. The authors identified the need for improvements in the follow-up of positive FOBTs, documentation of important elements in colonoscopy reports, and recommendations for rescreening or surveillance intervals after colonoscopy. Monitoring quality indicators is important to improve screening quality. Cancer 2013;119(15 suppl):2834-41. © 2013 American Cancer Society.
    Cancer 08/2013; 119 Suppl 15:2834-41. · 5.20 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Recommended colorectal cancer (CRC) screening tests for adults ages 50 to 75 years include home fecal occult blood tests (FOBT), sigmoidoscopy with FOBT, and colonoscopy. A newer test, computed tomographic (CT) colonography, has been recommended by some, but not all, national organizations. We analyzed 2010 National Health Interview Survey data, including new CT colonography questions, from respondents ages 50 to 75 years (N = 8,952). We (i) assessed prevalence of CRC test use overall, by test type, and by sociodemographic and health care access factors and (ii) assessed reported reasons for not having a CRC test. The age-standardized percentage of respondents reporting FOBT, sigmoidoscopy, or colonoscopy within recommended time intervals was 58.3% [95% confidence interval (CI), 57.0-59.6]. Colonoscopy was the most commonly reported test [within past 10 years: 54.6% (95% CI, 53.2-55.9)]. Home FOBT and sigmoidoscopy with FOBT were less frequently used [FOBT within past year: 8.8% (95% CI, 8.1-9.6); sigmoidoscopy within past 5 years with FOBT within past 3 years: 1.3% (95% CI, 1.0-1.6)]. CT colonography was rare: 1.3% (95% CI, 1.0-1.7). Increasing age, education, income, having health care insurance, and having a usual source of health care were associated with higher CRC test use. Test use within recommended time intervals was particularly low among individuals ages 50 to 64 years without health care insurance [21.2% (95% CI, 18.3-24.4)]. The most common reason for nonuse was "no reason or never thought about it." About 40% of Americans ages 50 to 75 years do not meet the recommendations for having CRC screening tests. Impact: Expanded health care coverage and greater awareness of CRC screening are needed to further decrease CRC mortality.
    Cancer Epidemiology Biomarkers &amp Prevention 04/2012; 21(6):895-904. · 4.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Prostate cancer has few known risk factors. As part of a population-based case-control study conducted in four health maintenance organizations, the authors examined the associations between fatal prostate cancer and several medical and behavioral characteristics. Cases were 768 health plan members who died of prostate adenocarcinoma during the period 1997-2001. We randomly selected controls (929) from the health plan membership and matched them to cases on health plan, age, race, and pattern of health plan membership. We examined medical records to obtain information on potential risk factors during the 10 years before the date on which prostate cancer was first suspected; the same reference date was used for the matched controls. Anthropometric characteristics, as well as personal histories of benign prostatic hypertrophy, transurethral prostatectomy, cancer, diabetes, prostatitis, hypertension, and vasectomy were largely similar for cases and controls. Men who died from prostate cancer were more likely than controls to have been cigarette smokers according to the most recent smoking notation before the reference date (odds ratio 1.5, 95% confidence interval 1.1-2.0). The observed increase in risk associated with recent cigarette smoking is consistent with the findings of several other studies. However, in contrast with some reports, we observed no connection between fatal prostate cancer and some prior health conditions or measures of body size.
    Cancer Causes and Control 10/2009; 21(1):117-25. · 3.20 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The risk of serious complications after colonoscopy has important implications for the overall benefits of colorectal cancer screening programs. We evaluated the incidence of serious complications within 30 days after screening or surveillance colonoscopies in diverse clinical settings and sought to identify potential risk factors for complications. Patients age 40 and over undergoing colonoscopy for screening, surveillance, or evaluation based an abnormal result from another screening test were enrolled through the National Endoscopic Database (CORI). Patients completed a standardized telephone interview approximately 7 and 30 days after their colonoscopy. We estimated the incidence of serious complications within 30 days of colonoscopy and identified risk factors associated with complications using logistic regression analyses. We enrolled 21,375 patients. Gastrointestinal bleeding requiring hospitalization occurred in 34 patients (incidence 1.59/1000 exams; 95% confidence interval [CI], 1.10-2.22). Perforations occurred in 4 patients (0.19/1000 exams; 95% CI, 0.05-0.48), diverticulitis requiring hospitalization in 5 patients (0.23/1000 exams; 95% CI, 0.08-0.54), and postpolypectomy syndrome in 2 patients (0.09/1000 exams; 95% CI, 0.02-0.30). The overall incidence of complications directly related to colonoscopy was 2.01 per 1000 exams (95% CI, 1.46-2.71). Two of the 4 perforations occurred without biopsy or polypectomy. The risk of complications increased with preprocedure warfarin use and performance of polypectomy with cautery. Complications after screening or surveillance colonoscopy are uncommon. Risk factors for complications include warfarin use and polypectomy with cautery.
    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 10/2009; 8(2):166-73. · 5.64 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Colorectal cancer (CRC) screening rates are low, and racial, ethnic, and economic disparities have been reported. Whether disparities in CRC screening have decreased over time is unknown. This study aimed to determine whether progress was made between 2000 and 2005 in reducing CRC screening disparities by race, ethnicity, income, and insurance status. Age-adjusted percentages of participants aged 50-64 who reported CRC screening (home fecal occult blood test in the past year or endoscopy in the past 10 years) were estimated from the 2000 (n=6,020 participants) and 2005 (n=6,706) cancer control supplements of the National Health Interview Survey, with analysis in 2007. Screening rates did not increase between 2000 and 2005 for Hispanic women or uninsured women. Only for high-income participants did screening exceed 50%. For both men and women, the uninsured had the lowest levels of screening (19.1% and 19.3%, respectively, in 2005), and the greatest disparities were observed among groups defined by health insurance status. For women, disparities by ethnicity, income, and insurance status increased over time, whereas among men, disparities in 2005 were similar to those in 2000. For Hispanic women, growing disparities were present at all income and insurance levels and persisted after additional adjustment. No progress was made in reducing most CRC screening disparities between 2000 and 2005. Methods are needed to increase CRC screening among everyone, but in particular Hispanic women and uninsured men and women.
    American Journal of Preventive Medicine 08/2008; 35(3):185-93. · 3.95 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Screening is effective in reducing colorectal cancer mortality. Recommended colorectal cancer screening options include a home fecal occult blood test (FOBT) or colorectal endoscopy (sigmoidoscopy or colonoscopy). Past surveys have indicated that colorectal cancer screening prevalence in the United States is low. The purpose of this analysis was to determine the prevalence of colorectal cancer test use in the United States by various factors and to examine reasons for not having a colorectal cancer test. Data on respondents ages > or =50 years from the 2005 National Health Interview Survey (n = 13,269) were analyzed. The proportion of the U.S. population that had home FOBT within the past year or endoscopy within the past 10 years was examined by sociodemographic, health-care access, and other health-related factors. Reported reasons for not having FOBT or endoscopy were also analyzed. The age-standardized proportion of respondents who reported FOBT within the past year and/or endoscopy within the past 10 years was 50.0% [95% confidence interval (95% CI), 48.8-51.2]. Colorectal cancer testing rates were particularly low among people without health-care coverage (24.1%; 95% CI, 19.2-29.7) or without a usual source of health care (24.7%; 95% CI, 20.8-29.0). The most commonly reported reason for not having a colorectal cancer test was "never thought about it." In 2005, about half of Americans ages > or =50 years did not have appropriate colorectal cancer testing. Increased efforts to expand health-care coverage or to provide colorectal cancer tests to people without health-care coverage are needed to increase colorectal cancer screening.
    Cancer Epidemiology Biomarkers &amp Prevention 07/2008; 17(7):1623-30. · 4.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine whether differences existed in prostate cancer treatment received by white and African American men at a health maintenance organization where access to medical care is theoretically equal for all members and, if so, to determine the reasons for these differences. We used information from the Kaiser Permanente Northwest Tumor Registry to identify all men diagnosed with local- or regional-stage prostate cancer between 1980 and 2000. We compared the likelihood of treatment with curative intent (TCI) between the two races, adjusting for age, tumor grade, stage, and the presence of comorbid conditions. We reviewed medical records of all 79 African American men and a sample of 158 white men (matched for age, stage, grade, and year of diagnosis) to determine the reasons that men did or did not receive TCI. Seventy-one percent of African American men and 82% of white men were treated with curative intent (P = 0.01). African American men were not more likely than white men to refuse TCI when it was offered (10.6% versus 8.1%, respectively; P = 0.6). However, urologists offered TCI less often to African American men than to white men (85% versus 91%, respectively; P = 0.02), and this difference could not be explained by differences in age, tumor grade, stage, or presence of comorbid conditions. African American men were less likely to receive TCI than white men. Because all of the men were insured, economic factors did not cause this difference. Furthermore, the cause did not seem to be differences in age, tumor grade, stage, or comorbid conditions.
    Urology 07/2008; 71(6):1172-6. · 2.42 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Few studies address the development of minor complications after screening or surveillance colonoscopy. Our purpose was to examine in previously asymptomatic people the incidence of new symptoms after colonoscopy, risk factors for symptoms, and patients' perceptions of this examination. Prospective cohort study. Patients completed a standardized interview at 7 and 30 days after colonoscopy. A total of 502 patients aged 40 years and older undergoing colonoscopy for colorectal cancer screening, surveillance, or follow-up of another abnormal screening test result. Patients were excluded if they had a history of inflammatory bowel disease, visible GI bleeding, or anemia. Incidence of minor complications and patient perceptions about colonoscopy. Minor complications occurred in 162 subjects (34%) before day 7 and in 29 subjects (6%) between day 7 and day 30, most commonly bloating (25%) and abdominal pain (11%). Six subjects had unexpected emergency department visits or hospitalizations within 30 days, including 2 with postpolypectomy bleeding. On multivariate analysis, minor complications were more common in women (odds ratio 1.78, 95% CI 1.21-2.62) and when the procedure lasted 20 minutes or longer. Bowel preparation was rated the most difficult part of the examination for 77%. Most subjects (94%) lost 2 or fewer days from normal activities for the colonoscopy itself, preparation, or recovery. Minor complications were common after screening and surveillance colonoscopy. The bowel preparation was the most difficult part of the examination for most patients. Most subjects lost 2 or fewer days from normal activities because of colonoscopy.
    Gastrointestinal Endoscopy 05/2007; 65(4):648-56. · 5.21 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Information about colonoscopy complications, particularly postpolypectomy bleeding, is limited. To quantify the magnitude and severity of colonoscopy complications. Retrospective cohort. Kaiser Permanente of Northern California. 16, 318 members 40 years of age or older undergoing colonoscopy between January 1994 and July 2002. Electronic records reviewed for serious complications, including hospital admission within 30 days of colonoscopy for colonic perforation, colonic bleeding, diverticulitis, the postpolypectomy syndrome, or other serious illnesses directly related to colonoscopy. 82 serious complications occurred (5.0 per 1000 colonoscopies [95% CI, 4.0 to 6.2 per 1000 colonoscopies]). Serious complications occurred in 0.8 per 1000 colonoscopies without biopsy or polypectomy and in 7.0 per 1000 colonoscopies with biopsy or polypectomy. Perforations occurred in 0.9 per 1000 colonoscopies (CI, 0.5 to 1.5 per 1000 colonoscopies) (0.6 per 1000 without biopsy or polypectomy and 1.1 per 1000 with biopsy or polypectomy). Postbiopsy or postpolypectomy bleeding occurred in 4.8 per 1000 colonoscopies with biopsy (CI, 3.6 to 6.2 per 1000 colonoscopies). Biopsy or polypectomy was associated with an increased risk for any serious complication (rate ratio, 9.2 [CI, 2.9 to 29.0] vs. colonoscopy without biopsy). Ten deaths (1 attributable to colonoscopy) occurred within 30 days of the colonoscopy. 99.3% (16 204) of colonoscopies were nonscreening examinations. The rate of complications may be lower in a primary screening sample. The small number of observed adverse events limited power to detect risk factors for complications. Colonoscopy with biopsy or polypectomy is associated with increased risk for complications. Perforation may also occur during colonoscopies without biopsies.
    Annals of internal medicine 01/2007; 145(12):880-6. · 13.98 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Public health practice often requires locating individuals in the community. This article presents information on the methods and amount of time and effort required to locate over 2300 low-income and minority women in Maryland, New York, Ohio, and Texas for a mammography rescreening study. In 1999, we identified 2528 low-income women who had a mammogram in 1997 funded by the National Breast and Cervical Cancer Early Detection Program. Starting 30 months after that mammogram, we made numerous attempts to locate each woman while recording the number of calls, letters, and tracing attempts used and the date she was found. More than 93% of the women were located. On average, it took 73.8 days (range 1-492 days) and 7.2 calls and letters (range 1-48) to reach each woman. Locating women in racial and ethnic minority groups required more time and effort. About 10% of all located women were found only after our subject tracing protocol was implemented. The percentage of located women increased markedly with more months of effort and additional calls and letters. Because women who were more difficult to locate were less likely to have been rescreened, the mammography rescreening percentages at the end of the study were slightly lower than they would have been had we terminated location efforts after 1-3 months. Locating low-income women in the community is difficult, particularly when obtaining a high response rate from all groups is important. Terminating data collection prematurely may decrease minority group representation and introduce bias.
    Journal of Community Health 07/2006; 31(3):249-61. · 1.28 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To examine the relationship between womens' experiences during mammography and their likelihood of being rescreened after receiving a negative or benign mammogram. Telephone interview and medical record data were collected from a random sample of enrollees from four states in a national screening program targeting uninsured and underinsured women at least 30 months after they had undergone an index mammogram in 1997. We calculated 30-month rescreening rates by prior mammography characteristics including pain and embarrassment, worry, convenience of appointment time, treatment by staff, and financial considerations. Of the 2,000 women in the sampling frame, 1,895 (93.6%) were located, 1,685 (88.6%) were interviewed and 1,680 provided data required for our analysis. Overall, 81.5% of the women had undergone rescreening. More than 90% of the women reported being 'satisfied' or 'very satisfied' with treatment by facility staff, facility location and wait time during the appointment. Statistically significant decreased rescreening rates were seen for women who reported feeling embarrassed and for women reporting dissatisfaction with ability to schedule a convenient appointment time. These results suggest that providing additional reassurance and privacy may increase rescreening rates.
    Cancer Causes and Control 06/2006; 17(4):439-47. · 3.20 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The potential role of prostate cancer screening in reducing mortality is uncertain. To examine whether screening with the prostate-specific antigen (PSA) test or digital rectal examination is associated with reduced prostate cancer mortality, we conducted a population-based case-control study in 4 health maintenance organizations. Cases were 769 health plan members who died because of prostate adenocarcinoma during the years 1997-2001. We randomly selected 929 controls from the health plan membership and matched them to cases on health plan, age, race, and membership history. Medical records were used to document all screening tests in the 10 years before and including the date on which prostate cancer was first suspected. Among white participants, 62% of cases and 69% of controls had a least 1 screening PSA test or digital rectal examination (odds ratio = 0.73; 95% confidence interval = 0.55-0.97). The corresponding proportions for blacks were 59% and 61% (1.0; 0.59-1.4). Most screening tests were digital rectal examinations; therefore, in the subgroup with no history of PSA screening, the association between digital rectal screening and prostate cancer mortality was similar to the overall association (0.65 [0.48-0.88] among whites; 0.86 [0.53-1.4] among blacks). Very few men received screening PSA without screening digital rectal examination (6% of cases and 7% of controls among whites). Digital rectal screening was associated with a reduced risk of death due to prostate cancer in our population. Because of several data limitations, this study could not accurately estimate the effect of PSA screening separate from digital rectal examination.
    Epidemiology 06/2005; 16(3):367-76. · 5.74 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Screening with the fecal occult blood test (FOBT) has been shown to reduce colorectal cancer incidence and mortality in randomized, controlled trials. Although the test is simple, implementation requires adherence to specific techniques of testing and follow-up of abnormal results. To examine how FOBT and follow-up are conducted in community practice across the United States. Cross-sectional national surveys of primary care physicians and the public. The Survey of Colorectal Cancer Screening Practices in Health Care Organizations and the 2000 National Health Interview Survey. 1147 primary care physicians who ordered or performed FOBT and 11 365 adults 50 years of age or older who responded to questions about FOBT use. Self-reported data on details of FOBT implementation and follow-up of positive results. Although screening guidelines recommend home tests, 32.5% (95% CI, 29.8% to 35.3%) of physicians used only the less accurate method of single-sample in-office testing; another 41.2% (CI, 38.3% to 44.0%) used both types of test. Follow-up of positive test results showed considerable nonadherence to guidelines, with 29.7% (CI, 27.1% to 32.4%) of physicians recommending repeating FOBT. Furthermore, sigmoidoscopy, rather than total colon examination, was commonly recommended to work up abnormal findings. Nearly one third of adults who reported having FOBT said they had only an in-office test, and nearly one third of those who reported abnormal FOBT results reported no follow-up diagnostic procedures. Limitations: The study was based on self-reports. Data from the National Health Interview Survey may underestimate the prevalence of in-office testing and inadequate follow-up. Mortality reductions demonstrated with FOBT in clinical trials may not be realized in community practice because of the common use of in-office tests and inappropriate follow-up of positive results. Education of providers and system-level interventions are needed to improve the quality of screening implementation.
    Annals of internal medicine 02/2005; 142(2):86-94. · 13.98 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Estimates of the current number of endoscopic colorectal cancer screening and follow-up examinations being performed are limited. A national study was therefore conducted among US physician practices. Approximately 1800 medical practices were surveyed from a list of all practices known to have purchased or leased lower endoscopic equipment between 1996 and 2000. Questions were asked regarding the current number of lower endoscopic procedures performed and the potential maximum number that could be performed. In 2002, a total of 8207 practices reported performing flexible sigmoidoscopy or colonoscopy in the United States. Gastroenterologists performed 43.7% (95% confidence interval [CI], 37.2-50.2) of all sigmoidoscopies and 82.5% (95% CI, 80.3-84.7) of all colonoscopies. Primary care physicians performed 24.9% (95% CI, 20.3-29.5) of all sigmoidoscopies and 2.0% (95% CI, 1.4-2.6) of all colonoscopies. All physicians combined performed approximately 2.8 million (95% CI, 2.4-3.1) flexible sigmoidoscopies and 14.2 million (95% CI, 12.1-16.4) colonoscopies but reported that they could increase to approximately 9.5 million flexible sigmoidoscopies (95% CI, 8.4-10.5) and 22.4 million colonoscopies (95% CI, 20.1-24.8) in 1 year. Approximately 2.8 million flexible sigmoidoscopies and 14.2 million colonoscopies were estimated to have been performed in 2002. Physicians reported that they could perform an additional 6.7 million flexible sigmoidoscopies and 8.2 million colonoscopies in 1 year. These additional procedures could be used for the unscreened population and should be considered in the estimate of the national capacity to provide colorectal cancer screening to all eligible persons in the United States.
    Gastroenterology 01/2005; 127(6):1670-7. · 12.82 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Screening is effective in reducing the incidence and mortality of colorectal cancer. Rates of colorectal cancer test use continue to be low. The authors analyzed data from the National Health Interview Survey concerning the use of the home-administered fecal occult blood test (FOBT) and sigmoidoscopy/colonoscopy/proctoscopy to estimate current rates of colorectal cancer test use and to identify factors associated with the use or nonuse of tests. In 2000, 17.1% of respondents reported undergoing a home FOBT within the past year, 33.9% reported undergoing an endoscopy within the previous 10 years, and 42.5% reported undergoing either test within the recommended time intervals. The use of colorectal cancer tests varied by gender, race, ethnicity, age, education, income, health care coverage, and having a usual source of care. Having seen a physician within the past year had the strongest association with test use. Lack of awareness and lack of physician recommendation were the most commonly reported barriers to undergoing such tests. Less than half of the U.S. population age >/= 50 years underwent colorectal cancer tests within the recommended time intervals. Educational initiatives for patients and providers regarding the importance of colorectal cancer screening, efforts to reduce disparities in test use, and ensuring that all persons have access to routine primary care may help increase screening rates.
    Cancer 06/2004; 100(10):2093-103. · 5.20 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides free cancer screening to many low-income, underinsured women annually but does not routinely collect all data necessary for precise estimation of mammography rescreening rates among enrollees. To determine the percentages rescreened and to identify factors that encourage on-schedule rescreening, telephone interview and medical record data were collected from 1685 enrollees in Maryland, New York, Ohio, and Texas at least 30 months after their 1997 index mammogram. Overall, 72.4% [95% confidence interval (95% CI) = 70.1-74.7] were rescreened within 18 months and 81.5% (95% CI = 79.6-83.5) within 30 months. At 30 months, the adjusted odds ratios (ORs) for rescreening were higher among Hispanics (OR = 1.95, 95% CI = 1.15-3.28), women with a history of breast cancer before the index mammogram (OR = 3.36, 95% CI = 1.07-10.53), and those who had used hormone replacement therapy before their index mammogram (OR =1.94, 95% CI = 1.30-2.91). The 30-month adjusted ORs were lower for women who reported poor health status (OR = 0.60, 95% CI = 0.42-0.85), did not have a usual source of care (OR = 0.61, 95% CI = 0.40-0.94), did not know if they could have another free mammogram (OR = 0.28, 95% CI = 0.14-0.51), described their index screen as their first mammogram ever (OR for no prior mammograms versus three or more = 0.40, 95% CI = 0.27-0.60), did not recall receiving a rescreening reminder (OR = 0.35, 95% CI = 0.25-0.48), or did not think they had been encouraged to rescreen by their provider (OR = 0.61, 95% CI = 0.44-0.86). Rescreening behavior in this sample of NBCCEDP enrollees was comparable with that observed in other populations. To facilitate routine rescreening among low-income women, ongoing efforts are needed to ensure that they receive annual reminders and encouragements from their medical providers and that they know how to obtain the services they need.
    Cancer Epidemiology Biomarkers &amp Prevention 05/2004; 13(4):620-30. · 4.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Flexible sigmoidoscopy (FS) is recommended for mass screening for colorectal cancer (CRC), yet little is known about the risk of adverse events when FS is used in general clinical practice. We aimed to determine the incidence of gastrointestinal complications and acute myocardial infarction (MI) after screening FS. Northern California Kaiser Permanente Medical Care Program members of average risk for CRC (n = 107,704) who underwent screening FS during 1994 to 1996 (109,534 FS), as part of the Colorectal Cancer Prevention (CoCaP) program. The main outcome measure was hospitalization for gastrointestinal complications or acute MI within 4 weeks of FS. The mean age of subjects was 61 years, and 48.8% were female. Nongastroenterologist physicians, nurses, or physician assistants performed 72% of FS. Overall, 24 persons were hospitalized for a gastrointestinal complication. Of these, 7 were serious (2 perforations, 2 episodes of diverticulitis requiring surgery, 2 cases of bleeding requiring transfusion, and 1 episode of unexplained colitis). In multivariate models, complications were significantly more common in men than in women (odds ratio, 3.34; 95% confidence interval [CI], 1.34-10.13). MI occurred in 33 persons within 4 weeks of FS, but the incidence for this period was similar to that in the subsequent 48 weeks (rate ratio, 0.8; 95% CI, 0.6-1.2). The risk of serious complications after screening FS in this setting appears to be modest. Although MI occurs after FS, the risk during the 4 weeks after the procedure appears to be similar to expectations for persons of screening age.
    Gastroenterology 01/2003; 123(6):1786-92. · 12.82 Impact Factor
  • Source
    Laura C Seeff, Jean A Shapiro, Marion R Nadel
    [Show abstract] [Hide abstract]
    ABSTRACT: To estimate current rates of use of fecal occult blood testing (FOBT) and sigmoidoscopy or colonoscopy; to determine whether test use varies by demographic factors; and to compare 1999 rates of use with 1997 rates. The Behavioral Risk Factor Surveillance System is an ongoing, state-based random-digit-dialed telephone survey of the US population that collects various health behavior information, including the use of colorectal cancer (CRC) screening tests. In 1999, 63,555 persons 50 years of age or older responded to questions regarding FOBT and sigmoidoscopy or colonoscopy. The proportion of survey respondents reporting having had FOBT and sigmoidoscopy/colonoscopy at any time; and the proportion reporting having had FOBT and sigmoidoscopy/colonoscopy within recommended time intervals. Data were recorded for the years 1997 and 1999, and analyzed according to various demographic factors. In 1999, 40.3% of respondents reported having had an FOBT at some time, and 43.8% reported having had a sigmoidoscopy or colonoscopy. Regarding recent test use, 20.6% of respondents reported having had an FOBT within the year, and 33.6% reported having had a sigmoidoscopy or colonoscopy within the past 5 years. Some demographic variation was noted. In 1997, 19.6% reported having had an FOBT within the year, and 30.3% reported having had a sigmoidoscopy or proctoscopy within the past 5 years. Use of CRC screening tests increased only slightly from 1997 to 1999. Usage remains low, despite consensus that screening for CRC reduces mortality from the disease. Efforts to promote awareness of, and screening for, CRC must intensify.
    The Journal of family practice 10/2002; 51(9):761-6. · 0.67 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The evidence is now compelling that colorectal cancer incidence and mortality can be reduced by screening, and medical organizations recommend regular screening among persons of average risk aged 50 years or older. We sought to determine whether appropriate screening has become more widespread now that consensus over its value has been achieved. We analyzed data from the 1992 and 1998 National Health Interview Survey, an in-person survey of a nationally representative sample of the U.S. population. Persons aged > or =50 years (4428 in 1992, 12,629 in 1998) were questioned about their use of colorectal cancer screening. Self-reported use of fecal occult blood testing and proctoscopy increased slightly from 1992 to 1998. In 1998, however, only an estimated 22.9% of Americans aged > or =50 years had been screened with either the home-administered fecal occult blood testing in the past year or proctoscopy within 5 years. Nearly half of fecal occult blood testings were performed with a sample taken during an in-office physical examination rather than with the recommended home kit. Most eligible persons are still not meeting the screening recommendations for colorectal cancer. Education is needed for both the public and health care providers to increase their compliance with current guidelines.
    Preventive Medicine 09/2002; 35(3):199-206. · 3.50 Impact Factor
  • J A Shapiro, L C Seeff, M R Nadel
    [Show abstract] [Hide abstract]
    ABSTRACT: Studies have shown that screening reduces colorectal cancer mortality. We analyzed national survey data to determine rates of use of fecal occult blood testing (FOBT) and sigmoidoscopy, and to determine if these rates differ by demographic factors and other health behaviors. A total of 52,754 respondents aged >or=50 years were questioned in the 1997 Behavioral Risk Factor Surveillance System (BRFSS) survey (a random-digit-dialing telephone survey of the non-institutionalized U.S. population) about their use of FOBT and sigmoidoscopy. The age-adjusted proportion of respondents who reported having had a colorectal cancer screening test during the recommended time interval (past year for FOBT and past 5 years for sigmoidoscopy) was 19.8% for FOBT, 30.5% for sigmoidoscopy, and 41.1% for either FOBT or sigmoidoscopy. Rates of use of colorectal cancer screening tests were higher for those who had other screening tests (mammography, Papanicolaou smear, and cholesterol check). There were also differences in rates of use of colorectal cancer screening tests according to other health behaviors (smoking, seat belt use, fruit and vegetable intake, and physical activity) and several demographic factors. However, none of the subgroups that we examined reported a rate of FOBT use above 29% within the past year or a rate of sigmoidoscopy use above 41% within the past 5 years. While rates of use of FOBT and sigmoidoscopy were higher among people who practiced other healthy behaviors, rates of use were still quite low in all subgroups. There is a need for increased awareness of the importance of colorectal cancer screening.
    American Journal of Preventive Medicine 09/2001; 21(2):132-7. · 3.95 Impact Factor

Publication Stats

1k Citations
129.24 Total Impact Points

Institutions

  • 2001–2012
    • Centers for Disease Control and Prevention
      • • Division Of Cancer Prevention and Control
      • • National Center for Chronic Disease Prevention and Health Promotion
      Atlanta, Michigan, United States
  • 2005–2009
    • Kaiser Permanente
      • Center for Health Research (Oregon, Hawaii, and Georgia)
      Oakland, California, United States