Associations in breast and colon cancer screening behavior in women

Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
Academic Radiology (Impact Factor: 1.75). 04/2005; 12(4):451-8. DOI: 10.1016/j.acra.2004.12.024
Source: PubMed


Gender-based psychosocial factors appear to influence colorectal cancer (CRC) screening adherence. Given its near-universal acceptance by the public, screening mammography represents a potential "teachable moment" for educating patients about the risk of CRC. Accordingly, to better understand screening behaviors among women, data from the Behavioral Risk Factors Surveillance Survey (BRFSS) were analyzed to identify potential relationships that would allow interventions to enhance CRC screening.
Women 50 years and older who participated in the BRFSS 2001 survey were included in the analysis. Colorectal, breast, and cervical cancer screening adherence with American Cancer Society guidelines was determined. We identified the association between breast and cervical cancer screening adherence and general health and demographic characteristics with CRC screening adherence.
After adjustment for sociodemographic factors in a multivariate analysis, women 60-69 years old (adjusted odds ratio [OR], 1.50; P < .01) and 70-79 years old (adjusted OR, 1.39; P < .01), having achieved at least some high school (adjusted OR, 1.62; P < .01) or college (adjusted OR, 2.11; P < .01) education, having health coverage (adjusted OR, 1.67; P < .01) or a personal physician (adjusted OR, 1.60; P < .01), and adherence to screening mammography (adjusted OR, 2.42; P < .01) and Pap smear (adjusted OR, 1.70; P < .01) were independently associated with an increased likelihood CRC screening adherence. Women in self-reported good general health were less likely to have adhered to CRC screening guidelines (adjusted OR, 0.79; P < .01). Current smokers were also less likely to have adhered to CRC screening guidelines than were women who never smoked or formerly smoked (adjusted OR, 0.76; P < .01). Participants who adhered to both mammography and Pap smear guidelines were significantly more likely to adhere to CRC screening (51.5% CRC screening adherence) compared with women who adhered to neither screening test (8.2% CRC screening adherence), with an adjusted OR of 5.67 (P < .001). Participants who adhered to both mammography and Pap smear guidelines were significantly more likely to adhere to CRC screening than were women who adhered to either screening test (38.0% CRC screening adherence) with an adjusted OR of 1.94 (P < .001).
Women with up-to-date mammography and cervical cancer screening were more likely to be up-to-date with CRC screening. Regardless of the increased association between non-CRC-related cancer screening and CRC screening, rates of CRC screening utilization remained low in these otherwise compliant populations.

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    • "ikely to obtain CRC screening ( Beydoun & Beydoun , 2008 ; Janz et al . , 2003 ; Partin et al . , 2010 ) . Not surprisingly , other health characteristics and preferences , such as having a smoking history , a chronic disease , and utilization of other preventive health services , also correlate with screening behavior ( Beydoun & Beydoun , 2008 ; Carlos et al . , 2005 ; Christman et al . , 2004 ; Meissner et al . , 2006 ; Smith , Cokkinides , & Eyre , 2003 ) ."
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    ABSTRACT: Colorectal cancer (CRC) is the third most deadly cancer in the United States. While there are several risk factors associated with the development of CRC, the most effective way to prevent CRC deaths is to promote regular screening. Despite strong evidence for the cost effectiveness of screening, compliance with recommended screenings is very low. This paper investigates the impact of mandated insurance coverage for CRC screening on CRC screening rates using a sample of insured adults from the Behavioral Risk Factor Surveillance Survey (BRFSS) from 2001 to 2008. To date, 34 states have mandated private health insurance coverage of colorectal screening. These mandates should reduce the cost of screening for some but not all privately insured patients. We find no evidence that mandates increased screening among males age 50 to 64 overall, though we do find weak evidence that mandates may have increased endoscopic only screening rates among females. However, these effects seem to be driven by a decline in endoscopic only screening among older women that is not observed in younger women. For both men and women, we find little evidence that mandates decreased the fraction of individuals who obtained no recent CRC screening.
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    • "Specifically, those that are (a) health promoting and have an ''indirect/ abstract'' or passive effect on health (e.g., exercising and routine medical care), and (b) health risks that have a more ''direct/ concrete'' or active effect on health, such as smoking and drinking. However, previous studies [6] [7] [8] [9] [10] [11] [12] [13] and our findings here that current smoking is associated with lower screening indicate that behaviors with passive and active effects may indeed cluster together. Furthermore, a recent study by Fang et al. [25] found that current smokers were more likely accept the HPV vaccination compared to non-smokers. "
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    ABSTRACT: We explored whether smoking is associated with cancer screening behaviors. We used data from the 2007 Florida Behavioral Risk Factor Surveillance System and the Florida Tobacco Callback Survey to examine screening behaviors related to four cancer types (breast, cervical, prostate, and colorectal). Using multiple logistic regression analyses, we examined the association between smoking status and health screening behaviors. For 10 of the 11 cancer screening variables, being a current smoker was significantly associated with being less likely to ever have been screened and also less likely to be compliant with screening guidelines. For breast and cervical cancer, level of nicotine dependence was also significantly related to compliance with screening recommendations; women with higher levels of dependence were less likely to be compliant. Our results support the notion that individuals' actions related to their health are consistent across different types of behaviors. We found that smokers were less likely to engage in cancer screening behaviors. In addition, among smokers, individuals with greater nicotine dependence had lower compliance with some screening tests. Physicians should ensure that their patients who smoke are receiving appropriate and adequate screening for cancer.
    Full-text · Article · Oct 2010
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    • "The patient's knowledge, attitudes, and beliefs towards colon cancer and chemotherapy may play key roles during the treatment decision making process [7]. Further, women who had regular mammograms were found to be more likely to have colorectal cancer screening [10]. Therefore, although regular mammography may reflect health status, mobility, and access to care, patients with regular mammography might be more aggressive in seeking health care and hold stronger beliefs in maintaining good health than those who did not have regular mammography use [11,12]. "
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    ABSTRACT: Although chemotherapy is not a routine recommendation for stage II colon cancer by the U.S. national guidelines, 20-30% of patients have received chemotherapy. This study investigated whether screening mammography use before the cancer diagnosis was associated with chemotherapy use among female elderly patients with stage II colon cancer. Retrospective cohort study on 2910 female stage II colon cancer patients aged 67-79 using the Surveillance, Epidemiology and End Results (SEER)-Medicare data (1996-2002). Screening mammography use and chemotherapy use were identified using Medicare claims data. Multivariate logistic regression and Kaplan-Meier curves were used. About 25% of female elderly patients received chemotherapy. The chemotherapy rates increased from 22% in 1996-1998 to 26% in 2001-2002. After adjusting for socio-demographic variables, tumor characteristics and Charlson index for comorbidities, the odds of receiving chemotherapy were 28% higher among those who had a screening mammogram before the cancer diagnosis than those who did not (OR: 1.28, 95% CI: 1.07-1.54). Those with a prior mammogram also received chemotherapy earlier than those without. In addition, patients with unfavorable tumor characteristics were more likely to receive chemotherapy. Mammography use before the cancer diagnosis was associated with favorable tumor characteristics. Despite the controversy about the chemotherapy use among stage II colon cancer, female elderly patients still received chemotherapy at a high rate. Our findings suggest that patient's health beliefs and health care seeking behavior, together with physician's recommendation, play important roles in the cancer treatment decision.
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