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
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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[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.
- "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. 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: Using the 1980 to 2002 General Social Survey, a repeated cross-sectional study that has been linked to the National Death Index through 2008, this study examines the changing relationship between self-rated health and mortality. Research has established that self-rated health has exceptional predictive validity with respect to mortality, but this validity may be deteriorating in light of the rapid medicalization of seemingly superficial conditions and increasingly high expectations for good health. Yet the current study shows the validity of self-rated health is increasing over time. Individuals are apparently better at assessing their health in 2002 than they were in 1980 and, for this reason, the relationship between self-rated health and mortality is considerably stronger across all levels of self-rated health. Several potential mechanisms for this increase are explored. More schooling and more cognitive ability increase the predictive validity of self-rated health, but neither of these influences explains the growing association between self-rated health and mortality. The association is also invariant to changing causes of death, including a decline in accidental deaths, which are, by definition, unanticipated by the individual. Using data from the final two waves of data, we find suggestive evidence that exposure to more health information is the driving force, but we also show that the source of information is very important. For example, the relationship between self-rated health and mortality is smaller among those who use the internet to find health information than among those who do not.
- "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  and physicians are more inclined to use screening [12,13]. These trends are likely relevant to the relationship between self-rated health and mortality. "
[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.
- " it is a risk factor or cause. A final related, but distinct issue, which may generate some of the observed international differences in prevalence concerns differential screening for disease, with cancer perhaps the best example. Screening is reported to be more aggressive for breast and prostate cancer in the US than in the UK and Western Europe. Howard et al. (2009) Screening may produce higher prevalence and incidence not only through earlier diagnosis but also through over-diagnosis and could plausibly contribute to lower incident mortality (i.e., a lower probability of death within a particular time-period following the diagnosis of a new condition) in the US compared to Western"