Article

Cancer Screening And Age In The United States And Europe

Department of Health Policy and Management, Rollins School of Public Health, at Emory University in Atlanta, Georgia, USA.
Health Affairs (Impact Factor: 4.97). 11/2009; 28(6):1838-47. DOI: 10.1377/hlthaff.28.6.1838
Source: PubMed
ABSTRACT
We compare cancer screening rates between the United States and Europe. Many European countries have organized screening programs, whereas the U.S. approach is relatively decentralized. Many European countries, unlike the United States, also impose upper age limits on screening. Overall, European screening rates were 22-88 percent of the corresponding U.S. rates. U.S. residents are more likely to be screened at younger ages, when the expected benefit from early detection is the greatest, but also at older ages, when the expected benefit is declining.

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    • "Response categories include a range of 1–5 years, ''more than 5 years,'' and ''never.'' The proportion of women screened calculated using MEPS closely matches the proportion calculated from the Health and Retirement Study but is higher than the proportion calculated using insurance claims[14]. Using the 2011 MEPS, we calculated the proportion of women aged 40–64 who were uninsured for the entire year, lived in households with incomes below 250 % of the federal poverty level, and reported having received a mammogram in the past 2 years. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective To describe the number and proportion of eligible women receiving mammograms funded by the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Methods Low-income, uninsured, and underinsured women aged 40–64 are eligible for mammography screening through the NBCCEDP. We used data from the NBCCEDP, the Current Population Survey, and Medical Expenditure Panel Survey to describe the number and proportion of women screened by the NBCCEDP and overall. Results In 2011 and 2012, the NBCCEDP screened 549,043 women aged 40–64, an estimated 10.6 % (90 % confidence interval [CI] 10.4–10.9 %) of the eligible population. We estimate that 30.6 % (90 % CI 26.4–34.8 %) of eligible women aged 40–64 were screened outside the NBCCEDP, and 58.8 % (90 % CI 54.6–63.0 %) were not screened. The proportion of eligible women screened by the NBCCEDP varied across states, with an estimated range of 3.2 % (90 % CI 2.9–3.5 %) to 52.8 % (90 % CI 36.1–69.6 %) and a median of 13.7 % (90 % CI 11.0–16.4 %). The estimated proportion of eligible women aged 40–64 who received mammograms through the NBCCEDP was relatively constant over time, 11.1 % (90 % CI 10.2–11.9 %) in 1998–1999 and 10.6 % (90 % CI 10.4–11.9 %) in 2011–2012 (p = 0.23), even as the number of women screened increased from 343,692 to 549,043. Conclusions Although the NBCCEDP provided screening services to over a half million low-income uninsured women for mammography, it served a small percentage of those eligible. The majority of low-income, uninsured women were not screened.
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    • "This increase in information is not only a reflection of technology or knowledge. Patients are demanding more information from their physicians than they did in the past [11] and physicians are more inclined to use screening [12,13]. These trends are likely relevant to the relationship between self-rated health and mortality. "
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    Full-text · Article · Jan 2014 · PLoS ONE
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    [Show abstract] [Hide abstract] ABSTRACT: We provide an overview of the growing literature that uses micro-level data from multiple countries to investigate health outcomes, and their link to socioeconomic factors, at older ages. Since the data are at a comparatively young stage, much of the analysis is at an early stage and limited to a handful of countries, with analysis for the US and England being the most common. What is immediately apparent as we get better measures is that health differences between countries amongst those at older ages are real and large. Countries are ranked differently according to whether one considers life-expectancy, prevalence or incidence of one condition or another. And the magnitude of international disparities may vary according to whether measures utilize doctor diagnosed conditions or biomarker-based indicators of disease and poor health. But one key finding emerges - the US ranks poorly on all indicators with the exception of self-reported subjective health status.
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