Screening rates for breast and cervical cancer have remained relatively stable over the past decade, with about 3 out of 4 eligible women receiving mammograms and 4 out of 5 having Pap tests to screen for cervical cancer. Target rates set by federal officials in the Healthy People 2020 initiative are 81% and 93%, respectively, for breast and cervical cancer screening.
Cancer Screening: Room for Improvement
Colorectal cancer screening rates are much lower, although more people than ever are being screened.
In 2010, about 59% of eligible men and women had colonoscopies or another colorectal cancer screening test -- well below the 70% target screening rate for both sexes.
Federal policymakers have concluded that the evidence is insufficient to recommend for or against screening men under the age of 75. Screening is not recommended for men 75 or older.
The cancer screening update appears in the Jan. 27 issue of the CDC’s Morbidity and Mortality Weekly Report.
“We have made progress, but breast and cervical cancer screening rates appear to have plateaued,” says Marcus Plescia, MD, MPH, who directs the CDC Division of Cancer Prevention and Control.
“We really need to get the numbers up for all three cancers. These are important tests. They can make a huge difference in our ability to treat these cancers early and effectively,” he says.
‘Affordable Care Act Having Impact’
Plescia says the sweeping federal health reform law has already had a positive impact on access to screening among insured Americans by requiring health insurers to cover the preventive tests. The law should have an even bigger impact when provisions expanding access to health care insurance kick in, he says.
But the report highlighted continuing racial, ethnic, and financial disparities in screening, finding that:
- Cancer screening rates were significantly lower among Asians -- 64% for breast cancer, 75% for cervical cancer, and 47% for colorectal cancer.
- Hispanics were less likely than non-Hispanics to be screened for cervical cancer (78.7% compared to 84%) and colorectal cancer (46.5% vs. 60%).
- People without health insurance were less likely to be screened for all three cancers than people with insurance.
Simple, Cheap Colorectal Test Underutilized
Current U.S. Preventive Services Task Force (USPSTF) cancer screening recommendations for people at average risk include:
- Breast cancer: Women aged 50 to 74 should be screened with a mammogram at least every two years. The decision to start screening before age 50 is an individual one and the patient's values regarding specific benefits and harms should be taken into account.
- Cervical cancer: Women who have been sexually active for three years, or are aged 21 through 65 and have not had their cervix removed during a hysterectomy, should be screened for cervical cancer with a Pap test at least every three years.
- Colorectal cancer: Men and women with an average risk for the cancer should be screened routinely at ages 50 through 75 with either colonoscopy testing at least every 10 years, sigmoidoscopy every five years combined with ecal occult blood testing (FOBT) every three years, or yearly fecal occult blood testing.
Plescia says while colonoscopy rates are going up, FOBT rates have gone down in recent years.
“That is disappointing because this is a simple, very inexpensive test,” he says. “Not everyone is going to have a colonoscopy, but everyone could have this test.”